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Sample records for consecutive scoliosis patients

  1. Vertebral and Intraspinal Anomalies in Indian Population with Congenital Scoliosis: A Study of 119 Consecutive Patients

    PubMed Central

    S, Rajasekaran; G, Balamurali; Shetty, Ajoy

    2016-01-01

    Study Design Retrospective case study by clinical and radiological data analysis. Purpose To analyze different types of vertebral anomalies and the incidence of associated intraspinal anomalies in the Indian population. Overview of Literature This is the largest study of congenital scoliosis and associated intraspinal anomalies in Indian population. Incidence of intraspinal anomaly in this series is 47% which is higher than previous literature. Hemivertebra was the most common anomaly as seen in previous studies. Methods A total of 119 patients with congenital scoliosis who underwent surgery between December 2006 and December 2012 were studied. Data was reviewed with medical records, plain radiographs, and magnetic resonance imaging (MRI) scans. Results Thoracolumbar curve was most common, seen in 43.6% of patients. In addition to scoliotic deformity, kyphosis was seen in 26% of patients. Failure of formation, the most common vertebral anomaly, was seen in 51.2% of patients, failure of segmentation was seen in 19.3% of patients, and there were 29.4% patients having both formation and segmentation anomalies. Hemivertebra was the most common vertebral anomaly seen in 66.3% of patients and for whom 63.2% were in thoracic spine. Intraspinal anomalies were associated with 47% of patients with congenital scoliosis. Tethered cord was the most common intraspinal abnormality and was found in 48.2% patients with intraspinal anomalies. The patients with failure of segmentation and mixed deformities were found to have a significantly higher incidence of intraspinal anomalies (65% and 57%, respectively) than those with failure of formation (34%). Out of 31 patients with kyphotic deformity 29% had intraspinal anomalies, and amongst them tethered cord was the most common anomaly seen in 66% patients. Out of 12 patients with neurocutaneous markers, 83% patients had intraspinal anomaly. Conclusions Intraspinal anomalies were seen in 47% of patients with congenital scoliosis in the

  2. Three-Dimensional Correction in Patients With Lenke 1 Adolescent Idiopathic Scoliosis: Comparison of Consecutive Versus Interval Pedicle Screw Instrumentation.

    PubMed

    Ketenci, Ismail Emre; Yanik, Hakan Serhat; Demiroz, Serdar; Ulusoy, Ayhan; Erdem, Sevki

    2016-01-01

    A retrospective-matched cohort study. To assess the correction of the adolescent idiopathic scoliosis (AIS) deformity in three dimensions, comparing consecutive and interval pedicle screw (PS) instrumentation techniques. The number of the sites that should be implanted with pedicle screws in AIS surgery is controversial. Coronal and sagittal planes have been investigated thoroughly but there are very little data about transverse plane correction according to PS density. A total of 76 AIS patients who underwent posterior fusion with PS instrumentation were recruited in this study. Patients were divided into two groups according to PS density with 38 patients in each group. In group 1, consecutive PS instrumentation was used (CPS group), and in group 2 interval pedicle screw instrumentation (IPS group). Two groups were matched according to similar patient age, fusion levels, curve magnitude and flexibility, identical Lenke curve type, and identical operative methods. Patients were compared at 1-year follow-up according to radiographic changes in coronal, sagittal, and transverse planes. Clinical outcomes were assessed using Scoliosis Research Society-22 and spinal appearance questionnaires. The two cohorts were well matched. At 1-year follow-up, major coronal Cobb angle changes were 45.4° in CPS group and 38.9° in IPS group (P = 0.049). T5-T12 sagittal Cobb angle changes were 5.1° and 5.9° in CPS and IPS groups, respectively (P = 0.897). Apical vertebral rotation changes were measured as 12.0° in CPS group and as 3.6° in IPS group, which demonstrated a significant difference (P = 0.001). Scoliosis Research Society-22 scores were similar in both groups, whereas spinal appearance questionnaire appearance domain was significantly better in CPS group at 1-year follow-up (P = 0.035). CPS provides better deformity correction in AIS surgery in all three planes, compared with IPS. Improved deformity correction results in better appearance outcomes. 3.

  3. Predictability of spontaneous thoracic curve correction after anterior thoracolumbar correction and fusion in adolescent idiopathic scoliosis. A retrospective study on a consecutive series of 29 patients with a minimum follow-up of 2 years.

    PubMed

    Huitema, Geertje C; Jansen, Rob C; van Ooij, André; Punt, Ilona M; van Rhijn, Lodewijk W

    2015-05-01

    According to the Lenke classification, a Type 5 adolescent idiopathic scoliosis can be surgically treated with selective anterior thoracolumbar or lumbar fusion. This study aims to predict the spontaneous correction of the unfused thoracic curve after anterior thoracolumbar fusion and to study whether age is of influence on this predictability. Retrospective study on a consecutive series of patients. Of a consecutive series of 38 patients with idiopathic thoracolumbar scoliosis, Lenke type 5, 29 patients were included in the study. All patients were treated with anterior spinal fusion and instrumentation. A minimum follow-up of 2 years was available for all patients (mean, 4 years; range, 2-17 years). To investigate the influence of age on the outcome, we divided the group into two subgroups: an adolescent (n=13) and an adult age group (n=16). The mean age in the adolescent group was 17 (range, 13-21 years) and 38 years (range, 22-54 years) in the adult group. Physiological measures include coronal Cobb angle, apical vertebral translation (AVT) and apical vertebral rotation (AVR), shoulder tilt, trunk shift, L4 tilt, and pelvic tilt. Relative corrections were computed for the thoracolumbar and thoracic curves in each patient using the following formula: (preoperative curve-postoperative curve)/preoperative curve×100 (%). The correlation coefficient between the relative (%) corrections of the thoracic and thoracolumbar curves was calculated for the whole group as for the two age subgroups. For radiographic evaluation, we used standing anteroposterior and lateral projections of the thoracolumbar spine to determine Cobb angle, AVT and AVR, and coronal balance. Both the thoracolumbar and thoracic curves in the whole group improved after surgery (45% and 19%, respectively, p<.01). In the adolescent age group, a significant correlation between the relative (%) correction of the thoracolumbar curve and the relative (%) correction of the thoracic curve was found (R=0

  4. Genetic Evaluation for the Scoliosis Gene(s) in Patients with Neurofibromatosis 1 and Scoliosis

    DTIC Science & Technology

    2013-08-01

    Adolescent Idiopathic Scoliosis (AIS) with a high degree of reliability. If the same genetic markers are present in non-dystrophic scoliosis then this...non-dystrophic scoliosis have a similar curve progression risk profile markers as patients with Adolescent Idiopathic Scoliosis . Dystrophic...Cobb angle in a growing spine) in adolescent idiopathic scoliosis patients. This study will attempt to confirm, in NF1 surgical patients with non

  5. [Halm-Zielke instrumentation as primary stable improvement of the Zielke-VDS in idiopathic scoliosis. 1 to 4 year outcome of a prospective study of 29 consecutive patients].

    PubMed

    Halm, H; Niemeyer, T; Halm, B; Liljenqvist, U; Steinbeck, J

    2000-06-01

    Halm-Zielke Instrumentation (HZI) was developed to eliminate the disadvantage of ventral derotation spondylodesis (VDS)-Zielke in terms of lack of primary stability and in order to simplify sagittal plane control. Within a prospective clinical trial started in 1993, we have studied whether HZI fulfills these demands. HZI is an anterior double-rod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS rod and a solid rod, which are attached to a hinge-conducted lid plate. Twenty-nine consecutive patients with idiopathic scoliosis and curves ranging from 36 degrees to 92 degrees were treated with HZI. The follow-up period ranged from 1 to 4 years. Correction of the frontal plane within the instrumented levels averaged 71.6% and 70.5% postoperatively and at follow-up, respectively. Derotation averaged 53.7% and mean correction of the tilt of the lowest instrumented vertebra was 69.5% at final follow-up. Thoracolumbar kyphosis was present in eight patients and was always completely corrected from +18.8 degrees to 3.3 degrees on average. One implant-related complication involved a screw breakage 18 months postoperatively without adverse effects. There was no case of pseudoarthrosis. All patients were mobilized without any additional external immobilization in terms of a brace or cast, and were allowed to go swimming for physiotherapeutical purposes immediately after wound healing. This study proves that HZI is a primary stable implant to perform VDS. Implant-related disadvantages typical of VDS are eliminated. Thereby, the period of rehabilitation is shortened by many months due to avoidance of cast and brace treatment.

  6. Scoliosis in patients with multiple hereditary exostoses.

    PubMed

    Matsumoto, Yoshihiro; Matsumoto, Kazu; Harimaya, Katsumi; Okada, Seiji; Doi, Toshio; Iwamoto, Yukihide

    2015-07-01

    To investigate the prevalence of and to identify independent predictors associated with scoliosis in patients with multiple hereditary exostoses (MHE). Fifty patients with MHE were clinically examined, and the diagnosis of scoliosis was made based on radiographs. To classify disease severity, three classes based on the presence of deformities and functional limitations were defined. Significant independent predictors of scoliosis in MHE were statistically analyzed. Scoliosis was present in 36 patients (MHE-scoliosis) (72 %). In the MHE-scoliosis group, the mean primary curve was 15.3° ± 5.7° (range 10°-34°) and the mean minor curve was 10.6° ± 7° (range 6°-32°). Left curve was predominant (72 %), and the apex was located in the thoracolumbar or lumbar spine in 64 % of patients. Univariable and multivariable analyses confirmed that MHE severity was a significant predictor of moderate scoliosis (≥20°). Our study confirmed that scoliosis is a common feature of MHE and disease severity is a predictor of moderate scoliosis (≥20°).

  7. Genetic Evaluation for the Scoliosis Gene(s) in Patients with Neurofibromatosis 1 and Scoliosis

    DTIC Science & Technology

    2012-08-01

    Adolescent Idiopathic Scoliosis (AIS) with a high degree of reliability. If the same genetic markers are present in non-dystrophic scoliosis then... Idiopathic Scoliosis . Dystrophic scoliosis patients will not have the same curve progression risk profile as AIS. To test this hypothesis this...intraobserver reproducibility of the system of King et al. for the classification of adolescent idiopathic scoliosis . J Bone Joint Surg Am. 1998

  8. Comparison of Consecutive, Interval, and Skipped Pedicle Screw Techniques in Moderate Lenke Type 1 Adolescent Idiopathic Scoliosis.

    PubMed

    Luo, Ming; Shen, Mingkui; Wang, Wengang; Xia, Lei

    2017-02-01

    To compare perioperative, radiographic, and Scoliosis Research Society-22 (SRS-22) outcomes of consecutive, interval, and skipped pedicle screw techniques in patients with moderate Lenke type 1 adolescent idiopathic scoliosis (AIS). We retrospectively reviewed 65 consecutive moderate Lenke type 1 AIS patients at a single institution using all-pedicle screw constructs, with a minimum of 2 years of follow-up. In the consecutive group (C group, n = 22), pedicle screws were instrumented at consecutive levels bilaterally. In the interval group (I group, n = 18), pedicle screws were placed at every level on the concave side while skipping levels on the convex side. In the skipped group (S group, n = 25), pedicle screws were instrumented by skipping levels bilaterally. Perioperative, radiographic, and SRS-22 measurements were analyzed with a 1-way analysis of variance. No significant differences were found in length of hospital stay, fused levels, coronal correction, and SRS-22 scores among the 3 groups. Increased surgery time was found in the C group compared with the I and S groups (P = 0.001 and P = 0.005, respectively). Decreased blood loss and blood transfusions were found in the S group compared with the C group (P = 0.04 and P = 0.047, respectively). Decreased implant costs were found in the S group compared with the C and I groups (P < 0.001 and P = 0.03, respectively). Consecutive, interval, and skipped pedicle screw techniques all provide satisfactory deformity correction and SRS-22 outcomes with few complications. With better perioperative outcomes, interval and skipped pedicle screw techniques are the more cost-effective options for patients with moderate Lenke type 1 AIS. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Genetic Evaluation for the Scoliosis Gene(s) in Patients with Neurofibromatosis Type I and Scoliosis

    DTIC Science & Technology

    2011-08-01

    type 1 patients with non-dystrophic scoliosis have a similar curve progression risk profile markers as patients with Adolescent Idiopathic Scoliosis ...curves (> 40 degree Cobb angle in a growing spine) in adolescent idiopathic scoliosis patients. This study will attempt to confirm, in NF1 surgical...Interobserver reliability and intraobserver reproducibility of the system of King et al. for the classification of adolescent idiopathic scoliosis

  10. Effect of patient position on the lordosis and scoliosis of patients with degenerative lumbar scoliosis.

    PubMed

    Fei, Han; Li, Wei-Shi; Sun, Zhuo-Ran; Jiang, Shuai; Chen, Zhong-Qiang

    2017-08-01

    This study aimed to analyze the effect of patient positions on the lordosis and scoliosis of patients with degenerative lumbar scoliosis (DLS).Seventy-seven patients with DLS were retrospectively analyzed. We measured lordosis and Cobb's angle on preoperative upright x-rays and magnetic resonance imagings in supine position. The lordosis and scoliosis of surgical segments in intraoperative prone position were measured on intraoperative radiographs of 20 patients to compare with that in standing position. Paired t tests were performed to investigate the parameters of the sample.From standing to supine position the whole lordosis increased (29.2 ± 15.7 degree vs. 34.9 ± 11.2 degree), and the whole scoliosis decreased (24.3 ± 11.8 degree vs. 19.0 ± 10.5 degree); 53 of 77 (68.8%) cases had increased lordosis, and 67 of 77 (87%) cases had decreased scoliosis. The lordosis of surgical segments in standing position had no difference with that in intraoprerative prone position. But in changing from supine/standing position to intraoprerative prone position, the scoliosis of surgical segments decreased (14.7 ± 9.4 degree vs. 11.4 ± 7.0 degree; 19.0 ± 11.8 degree vs. 11.4 ± 7.0 degree, respectively), and 18 of 20 (90%) cases had decreased scoliosis in intraoperative prone position than that in standing position.Compared with standing position in DLS patients, supine position increased lordosis and reduced scoliosis, and intraoperative prone position reduced scoliosis significantly. When evaluating the severity of DLS and making preoperative surgical plans, lumbar lordosis in supine position should also be evaluated in addition to upright x-ray, and the effects of different positions should be taken into consideration to reduce deviation.

  11. Preoperative urinary tract obstruction in scoliosis patients.

    PubMed

    Suzuki, Shigeru; Kotani, Toshiaki; Mori, Kazuetsu; Kawamura, Ken; Ohtake, Akira

    2017-01-01

    While the association between scoliosis and cardiac and respiratory function impairments has been well characterized in clinical practice and research, the potential effect of scoliosis on urinary tract structure and renal function has received little attention. Therefore, the purpose of this study was to evaluate the preoperative clinical characteristics of urinary tract structure and renal function in pediatric patients with idiopathic scoliosis, using a combination of blood tests, urinalysis, and imaging. Preoperative measures of urinary tract structure and renal function were obtained for 16 patients, 13-17 years old, scheduled for corrective surgery for idiopathic scoliosis. Preoperative assessment included blood test and urinalysis, combined with structural imaging on ultrasound (US), magnetic resonance imaging (MRI), magnetic resonance urography (MRU), and radioisotope tracing (RI), using technetium-99 m mercaptoacetyltriglycine ((99m) Tc-MAG3). Differences in blood and urine tests between patients with and without urinary tract obstruction (UTO) were evaluated for significance using Mann-Whitney U test. For all 16 patients, blood tests and MRU were within normal limits. Dilatation of the renal pelvis was identified on US in eight patients (50.0%). UTO was identified on RI in six patients (37.5%). UTO was associated with elevated β2-microglobulin concentration. Urinary β2-microglobulin concentration >0.7 μg/mg Cr differentiated patients with UTO from those without UTO, with a sensitivity of 100% and specificity of 70%. β2-Microglobulin concentration may be a useful marker to screen for asymptomatic UTO in patients with idiopathic scoliosis. © 2016 Japan Pediatric Society.

  12. Scoliosis

    MedlinePlus

    Scoliosis causes a sideways curve of your backbone, or spine. These curves are often S- or C-shaped. Scoliosis is most common in late childhood and the ... but not always. Children may get screening for scoliosis at school or during a checkup. If it ...

  13. Preoperative evaluation of activity and function in patients with paralytic scoliosis.

    PubMed

    Larsson, E L; Aaro, S; Ahlinder, P; Oberg, B

    1998-01-01

    Preoperative evaluation of patients with paralytic scoliosis should take into account the consequences of surgery on the every day life of the patient. However, the parameters that are customarily used in these operations relate only to very narrow measures such as the angle of scoliosis or kyphosis. The aim of this study was to introduce a set of instruments appropriate for measuring both function and activities in paralytic scoliosis patients. The study took as its starting point the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH), in which an activity is described at the level of the individual and function at the level of the organ. A consecutive series of 100 paralytic scoliosis patients with 18 different diagnoses were evaluated preoperatively with a set of instruments that had been specially developed at Linköping hospital, in which the variables are classified according to the system used in the ICIDH. The set of instruments included general information and evaluation of activities and function--sitting, balance, weight distribution to sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Barthel and ADL Klein and Bell, care given, time spent resting, and seating supports). The results showed that patients with paralytic scoliosis constitute a heterogeneous group in activities and function. Even when the patients were grouped into four subgroups according to the Scoliosis Research Society Classification, they remained very heterogeneous. However, reaching, Klein and Bell Activities of Daily Living and pain could only evaluate patients who could understand verbal instructions. In those who could not, assessment relied more heavily on measures of function and level of dependence. It was concluded that the choice of assessment must be guided by the patient's ability to understand verbal instructions irrespective of his/her disorder. It is important to use the three levels

  14. [Sports capacity of patients with scoliosis].

    PubMed

    von Strempel, A; Scholz, M; Daentzer, M

    1993-06-01

    The burden of sport of patients with scoliosis depends on the age, the expected progredience of the deformity and the attained deformation. In children and teenagers treated with an orthesis, total prohibition is not appropriate. All kinds of sport not involving any risk of injury to the participant or the patient wearing an orthesis can be practised. The orthesis may be removed only during swimming. For patients with a fused spine the number of the remaining lumbar moving segments and the deformity are essential for the exercise load. If there are less than three free lumbar segments all kinds of sport with axial and rotationary burdens are not to be recommended. If the spinal bending is more than 50 degrees (Cobb) the limitation of the cardiopulmonary ability is even more severe.

  15. Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

    PubMed

    Sarwahi, Vishal; Amaral, Terry; Wendolowski, Stephen; Gecelter, Rachel; Gambassi, Melanie; Plakas, Christos; Liao, Benita; Kalantre, Sarika; Katyal, Chhavi

    2015-01-01

    Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

  16. Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis

    PubMed Central

    Sarwahi, Vishal; Amaral, Terry; Wendolowski, Stephen; Gecelter, Rachel; Gambassi, Melanie; Plakas, Christos; Liao, Benita; Kalantre, Sarika; Katyal, Chhavi

    2015-01-01

    Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations. PMID:26649305

  17. Minimally invasive scoliosis surgery: an innovative technique in patients with adolescent idiopathic scoliosis

    PubMed Central

    2011-01-01

    Minimally invasive spine surgery is becoming more common in the treatment of adult lumbar degenerative disorders. Minimally invasive techniques have been utilized for multilevel pathology, including adult lumbar degenerative scoliosis. The next logical step is to apply minimally invasive surgical techniques to the treatment of adolescent idiopathic scoliosis (AIS). However, there are significant technical challenges of performing minimally invasive surgery on this patient population. For more than two years, we have been utilizing minimally invasive spine surgery techniques in patients with adolescent idiopathic scoliosis. We have developed the present technique to allow for utilization of all standard reduction maneuvers through three small midline skin incisions. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, and allows adequate facet osteotomy to enable fusion. There are multiple potential advantages of this technique, including: less blood loss, shorter hospital stay, earlier mobilization, and relatively less pain and need for pain medication. The operative time needed to complete this surgery is longer. We feel that a minimally invasive approach, although technically challenging, is a feasible option in patients with adolescent idiopathic scoliosis. Although there are multiple perceived benefits, long term data is needed before it can be recommended for routine use. PMID:21834988

  18. Preoperative Magnetic Resonance Imaging Evaluation in Patients with Adolescent Idiopathic Scoliosis

    PubMed Central

    Lee, Choon Sung; Kim, Nam Heun; Noh, Hyun Min; Lee, Mi Young; Yoon, So Jung; Lee, Dong-Ho

    2017-01-01

    Study Design Retrospective case series. Purpose The purpose of this study was to examine the incidence of neural axis abnormalities and the relevant risk factors in patients with adolescent idiopathic scoliosis (AIS). Overview of Literature The use of preoperative magnetic resonance imaging (MRI) to assess the whole spine in patients with idiopathic scoliosis is controversial, and indications for such MRI evaluations have not been definitively established. However, we routinely use whole-spine MRI in patients with scoliosis who are scheduled to undergo surgical correction. Methods A total of 378 consecutive patients with presumed AIS who were admitted for spinal surgery were examined for neural axis abnormalities using MRI. To differentiate patients with normal and abnormal MRI findings, the following clinical parameters were evaluated: age, sex, menarcheal status, rotation angle (using a scoliometer), coronal balance, shoulder height difference, and low back pain. We radiographically evaluated curve type, thoracic or thoracolumbar curve direction, curve magnitude and flexibility, apical vertebral rotation, curve length, coronal balance, sagittal balance, shoulder height difference, thoracic kyphosis, and the Risser sign. Results Neural axis abnormalities were detected in 24 patients (6.3%). Abnormal MRI findings were significantly more common in males than in females and were associated with increased thoracic kyphosis. However, there were no significant differences in terms of the other measured parameters. Conclusions Among the patients with presumed AIS who received preoperative whole-spine MRI, 6.3% had neural axis abnormalities. Males and patients with increased thoracic kyphosis were at a higher risk. PMID:28243367

  19. Genetic Evaluation for the Scoliosis Gene(s) in Patients with Neurofibromatosis 1 and Scoliosis

    DTIC Science & Technology

    2015-10-01

    an existing genetic test used to predict scoliosis progression in adolescent idiopathic scoliosis could also identify dystrophic scoliosis in NF1...course of non-dystrophic scoliosis is more benign than dystrophic, and similar to that of adolescent idiopathic scoliosis (AIS). 3,4 NF1 dystrophic...distinct vertebral malformations, progresses rapidly, and curve progression may accelerate at any time, often independent of the adolescent growth spurt

  20. Experience in Perioperative Management of Patients Undergoing Posterior Spine Fusion for Neuromuscular Scoliosis

    PubMed Central

    Peltier, Emilie; Launay, Franck; Fuentes, Stéphane; Bollini, Gérard; Viehweger, Elke; Jouve, Jean-Luc

    2016-01-01

    The objective of this investigation was to determine the outcome of spine fusion for neuromuscular (NM) scoliosis, using Unit Rod technique, with emphasis on complications related to preoperative general health. Between 1997 and 2007, 96 consecutive patients with neuromuscular scoliosis operated on with Unit Rod instrumentation were retrospectively reviewed. The inclusion criteria were diagnosis of NM scoliosis due to cerebral palsy (CP) and muscular dystrophy (DMD). Patient's preoperative general health, weight, and nutrition were collected. Different radiographic and clinical parameters were evaluated. There were 66 CP patients (59 nonwalking) and 30 DMD patients (24 nonwalking). Mean age at surgery was 16.5 years and 13.9 years, respectively. All radiographic measurements improved significantly. Wound infection rate was 16.7% (11% of reoperation rate in CP; 10% in DMD; 3 hardware removal cases). No pelvic fracture due to rod irritation was observed. Unit Rod technique provides good radiographic and clinical outcomes even if this surgery is associated with a high complication rate. It is a quick, simple, and reliable technique. Perioperative management strategy should decrease postoperative complications and increases outcome. A standardized preoperative patient evaluation and preparation including respiratory capacity and nutritional, digestive, and musculoskeletal status are mandatory prior to surgery. PMID:28058256

  1. Body image in patients with adolescent idiopathic scoliosis: validation of the Body Image Disturbance Questionnaire--Scoliosis Version.

    PubMed

    Auerbach, Joshua D; Lonner, Baron S; Crerand, Canice E; Shah, Suken A; Flynn, John M; Bastrom, Tracey; Penn, Phedra; Ahn, Jennifer; Toombs, Courtney; Bharucha, Neil; Bowe, Whitney P; Newton, Peter O

    2014-04-16

    Appearance concerns in individuals with adolescent idiopathic scoliosis can result in impairment in daily functioning, or body image disturbance. The Body Image Disturbance Questionnaire (BIDQ) is a self-reported, seven-question instrument that measures body image disturbance in general populations; no studies have specifically examined body image disturbance in those with adolescent idiopathic scoliosis. This study aimed to validate a modified version of the BIDQ in a population with adolescent idiopathic scoliosis and to establish discriminant validity by comparing responses of operatively and nonoperatively treated patients with those of normal controls. In the first phase, a multicenter study of forty-nine patients (mean age, fourteen years; thirty-seven female) with adolescent idiopathic scoliosis was performed to validate the BIDQ-Scoliosis version (BIDQ-S). Participants completed the BIDQ-S, Scoliosis Research Society (SRS)-22, Children's Depression Index (CDI), and Body Esteem Scale for Adolescents and Adults (BESAA) questionnaires. Descriptive statistics and Pearson correlation coefficients were calculated. In the second phase, ninety-eight patients with adolescent idiopathic scoliosis (mean age, 15.7 years; seventy-five female) matched by age and sex with ninety-eight healthy adolescents were enrolled into a single-center study to evaluate the discriminant validity of the BIDQ-S. Subjects completed the BIDQ-S and a demographic form before treatment. Independent-sample t tests and Pearson correlation coefficients were calculated. The BIDQ-S was internally consistent (Cronbach alpha = 0.82), and corrected item total correlations ranged from 0.47 to 0.67. The BIDQ-S was significantly correlated with each domain of the SRS-22 and the total score (r = -0.50 to -0.72, p ≤ 0.001), with the CDI (r = 0.31, p = 0.03), and with the BESAA (r = 0.60, p < 0.001). BIDQ-S scores differed significantly between patients (1.50) and controls (1.06, p < 0.005), establishing

  2. Scoliosis-related factors in patients with rheumatoid arthritis: A cross-sectional study.

    PubMed

    Mochizuki, Takeshi; Yano, Koichiro; Ikari, Katsunori; Hiroshima, Ryo; Takaoka, Hiromitsu; Kawakami, Kosei; Koenuma, Naoko; Ishibashi, Mina; Shirahata, Toshikatsu; Momohara, Shigeki

    2016-01-01

    This study aimed to identify the prevalence of scoliosis and scoliosis-related factors of rheumatoid arthritis (RA). In this study, 411 patients who underwent coronal total spine and lower limb radiography were enrolled. Patients with a Cobb angle ≥10° were diagnosed with scoliosis. Statistical analysis was performed to compare between patients with and those without scoliosis, and between patients without scoliosis and those with a Cobb angle >20°. The prevalence of scoliosis in patients with RA was 30.7%. The mean Cobb angles were 8.5° ± 7.2° in all the patients, 16.1° ± 8.6° in patients with scoliosis, and 5.1° ± 2.3° in patients without scoliosis. According to a multivariate analysis, the scoliosis-related factors of RA were age and vertebral fracture. Significant differences in age, corticosteroid use, and malalignment of lower limbs were observed between patients with a Cobb angle >20° and those without scoliosis. With RA treatment, the need for corticosteroid use is reduced and vertebral fracture is prevented. Moreover, the joints and spinal and lower limb alignments should be examined.

  3. Assessment of Idiopathic Scoliosis Patients' Satisfaction with Thoracolumbar Brace Treatment.

    PubMed

    Kwiatkowski, Michał; Mnich, Krystian; Karpiński, Michał; Domański, Krzysztof; Milewski, Robert; Popko, Janusz

    2015-01-01

    Bracing is the most efficient non-surgical method of treatment for idiopathic scoliosis patients with 25-45° curvature according to Cobb. The aim of the present study was to assess compliance of idiopathic scoliosis patients with medical instructions concerning the time patients should spend wearing orthopedic braces, patients' self-perceived health status and problems occurring in patients with idiopathic scoliosis. A total of 51 patients aged between 9 to 18 years (84% females) treated for adolescent idiopathic scoliosis with a thoracolumbar brace were asked to complete a survey titled ''The profile of quality of life with spine deformity". Survey data were subjected to statistical analysis. Mean brace-wearing compliance among the patients was about 70% of the required time of 23 h/day. The vast majority of patients - 48 (94%) -were satisfied with the treatment method and the results. Pain of about 4 pts (VAS scale) was reported by 18 patients. Excoriations occurred in 70% of the patients. We did not find a significant correlation between the time of brace-wearing per day vs. pain (p=0.18) and excoriations (p=0.36). 1. Increasing the number of brace-wearing hours per day does not interfere with the socioeconomic relations and does not affect the child's sleep quality. 2. High awareness of the faulty posture is an important factor improving patients' assessment of the progress and methods of treatment. 3. The number of brace-wearing hours per day does not correlate with pain and epidermal injury; appropriate fitting of the brace to a given patient is of key importance here.

  4. [Analysis of the quality of life in patients affected by scoliosis].

    PubMed

    Leal-Hernández, M; Martínez-Monje, F; Pérez-Valencia, M; García-Romero, R; Mena-Poveda, R; Caballero-Cánovas, J

    2017-05-11

    To assess the quality of life using the SRS 22 test in patients with scoliosis of 20 or more degrees Cobb. A prospective descriptive study was conducted between April and May 2016 on patients with scoliosis of at least 20 degrees Cobb and aged between 10 and 20 years. A record was made of weight, height, body mass index, and the SR 22 specific quality of life questionnaire for patients with scoliosis was completed. Patients were divided into two groups for analysis: a) scoliosis between 20 and 29 degrees Cobb (n=44); and b) scoliosis with a Cobb of 30 degrees or greater (n=32). There were significant differences in the dimensions that assess pain, image self-perception, and satisfaction with treatment, being valued worse when the degree of scoliosis Cobb is 30 degrees or higher. There were no significant differences in function/activity or mental health. The overall score of the questionnaire was also worse in the group with the highest degree of scoliosis. The weight, height, and BMI showed no significant differences due to the varying degrees of scoliosis. Scoliosis significantly affects the quality of life of people who suffer it, and there is a negative correlation between the severity of scoliosis measured by degrees Cobb and quality of life. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Severe scoliosis in a patient with severe methylenetetrahydrofolate reductase deficiency.

    PubMed

    Munoz, Tatiana; Patel, Jinesh; Badilla-Porras, Ramses; Kronick, Jonathan; Mercimek-Mahmutoglu, Saadet

    2015-01-01

    Severe methylenetetrahydrofolate reductase (MTHFR) deficiency is a rare autosomal recessively inherited inborn error of folate metabolism. We report a new patient with severe MTHFR deficiency who presented at age 4 months with early onset severe scoliosis associated with severe hypotonia. Markedly decreased MTHFR enzyme activity (0.3 nmoles CHO/mg protein/h; reference range>9) and compound heterozygous mutations (c. 1304T>C; p.Phe435Ser and c.1539dup; p.Glu514Argfs∗24) in the MTHFR gene confirmed the diagnosis. She was treated with vitamin B12, folic acid and betaine supplementation and showed improvements in her developmental milestones and hypotonia. To the best of our knowledge, this is the first patient with MTHFR deficiency reported with severe early onset scoliosis. Despite the late diagnosis and treatment initiation, she showed favorable short-term neurodevelopmental outcome. This case suggests that homocysteine measurement should be included in the investigations of patients with developmental delay, hypotonia and scoliosis within first year of life prior to organizing genetic investigations.

  6. Validation of a Japanese version of the Scoliosis Research Society-22 Patient Questionnaire among idiopathic scoliosis patients in Japan.

    PubMed

    Hashimoto, Hideki; Sase, Takeshi; Arai, Yasuhisa; Maruyama, Toru; Isobe, Keijirou; Shouno, Yasuhiro

    2007-02-15

    A cross-sectional observational study to determine the response distribution, internal consistency, and construct, concurrent, and discriminative validities of The Scoliosis Research Society-22 (SRS-22) Patient Questionnaire translated into Japanese as compared with the other language versions. To validate the Japanese version of SRS22. The SRS-22 was translated into several languages but yet not into Japanese. The Japanese SRS-22 and Medical Outcomes Study Short Form 36 were simultaneously administered to 114 adolescent idiopathic scoliosis patients. Exploratory factor analysis revealed a 4-factor structure, though several items were not loaded as theoretically expected. The originally constructed Japanese SRS-22 subscales and the English version showed similar response distribution. Internal consistency was fair but lower than that of the English version. The concurrent validity of the translated version, except for the self-image subscale, was supported using Medical Outcomes Study Short Form 36 subscales as a reference. The function scale differed significantly by curve angle magnitude and treatment status. The self-image score was the highest in patients under observation when curve angle was < 40 degrees, while postsurgical patients marked the highest scores when the angle > or = 40 degrees, respectively. The Japanese SRS-22 is valid and may be useful for clinical evaluation of Japanese scoliosis patients, though the self-image subscale may need further assessment.

  7. Radiation exposure to patients receiving routine scoliosis radiography measured at depth in an anthropomorphic phantom

    SciTech Connect

    Dutkowsky, J.P.; Shearer, D.; Schepps, B.; Orton, C.; Scola, F. )

    1990-07-01

    Concern about the amount of radiation received during scoliosis evaluation and treatment led us to measure radiation exposure in an anthropomorphic phantom to determine the increased risk of breast cancer in young women with scoliosis. Assuming that 22 radiographic examinations were performed over the course of scoliosis treatment, the increased relative risk of breast cancer was determined to be 0.22% in these patients.

  8. Management of scoliosis in patients with Duchenne muscular dystrophy and spinal muscular atrophy: A literature review.

    PubMed

    Garg, Sumeet

    2016-01-01

    Scoliosis occurs in nearly all non-ambulatory children with spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD). Non-operative treatments have not been shown to be effective at preventing progression of scoliosis. Progressive scoliosis can impact the ability of patients to sit comfortably, be cosmetically unappealing, and in severe cases exacerbate pulmonary disease. The main goal of operative treatment is to improve sitting balance and prevent progression of scoliosis. Complication rates are high and there is little data on effect of operative treatment on quality of life in children with SMA and DMD. Comprehensive multi-disciplinary pre-operative evaluations are vital to reduce the risks of operative treatment.

  9. Forces exerted during exercises by patients with adolescent idiopathic scoliosis wearing fiberglass braces

    PubMed Central

    Romano, Michele; Carabalona, Roberta; Petrilli, Silvia; Sibilla, Paolo; Negrini, Stefano

    2006-01-01

    Objective To quantify and compare the forces exerted by scoliosis patients in fiberglass braces during exercises usually prescribed in departments where casts are made. The exercises are intended to increase corrective forces, activate muscles, stimulate ventilation and help the patient psychologically. Setting Outpatient care. Patients 17 consecutive adolescent patients wearing fiberglass brace for idiopathic scoliosis. Interventions Exercises (kyphotization, rotation, "escape from the pad") in different positions (sitting, supine, on all fours). Main outcome measure Pressure detected by the F-Socket System between the rib hump and the pad of the brace. Results In static and dynamic conditions, the position adopted did not alter the total pressure exerted by the brace, although the part of the sensor stimulated did vary. Kyphotization and rotation exercises produced a significant increase of pressure (+ 58.9% and +29.8%, respectively); however, the "escape from the pad" exercise, despite its name, did not produce any significant variation of pressure. Conclusion Exercises in the brace allow adjunctive forces to be applied on soft tissues and through them, presumably on the spine. Different exercises can be chosen to obtain different actions. Physical exercises and sporting activities are useful in mechanical terms, although other important actions should not be overlooked. PMID:16859544

  10. Scoliosis related information on the internet in China: can patients benefit from this information?

    PubMed

    Bao, Hongda; Zhu, Feng; Wang, Fei; Liu, Zhen; Bao, Mike H; He, Shouyu; Zhu, Zezhang; Qiu, Yong

    2015-01-01

    There has been an increasing popularity of searching health related information online in recent years. Despite that considerable amount of scoliosis patients have shown interest in obtaining scoliosis information through Internet, previous studies have demonstrated poor quality of online information. However, this conclusion may vary depending on region and culture. Since China has a restricted Internet access outside of its borders, the aim of this study is to evaluate the quality of scoliosis information available online using recognized scoring systems and to analyze the Internet as a source of health information in China. A survey-based questionnaire was distributed to 280 respondents at outpatient clinics. Information on demographics and Internet use was collected. Binary logistic analysis was performed to identify possible predictors for the use of Internet. In addition, the top 60 scoliosis related websites assessed through 4 search engines were reviewed by a surgeon and the quality of online information was evaluated using DISCERN score and JAMA benchmark. Use of the Internet as a source for scoliosis related information was confirmed in 87.8% of the respondents. College education, Internet access at home and urban residence were identified as potential predictors for Internet use. However, the quality of online scoliosis related information was poor with an average DISCERN score of 27.9±11.7 and may be misleading for scoliosis patients. The study outlines the profile of scoliosis patients who use the Internet as a source of health information. It was shown that 87.8% of the scoliosis patients in outpatient clinics have searched for scoliosis related information on Internet. Urban patients, higher education and Internet access at home were identified as potential predictors for Internet search. However, the overall quality of online scoliosis related information was poor and confusing. Physician based websites seemed to contain more reliable information.

  11. Comparison of respiratory muscles activity and exercise capacity in patients with idiopathic scoliosis and healthy individuals.

    PubMed

    Mohammadi, Pirayeh; Akbari, Mohammad; Sarrafzadeh, Javad; Moradi, Zahra

    2014-11-01

    Idiopathic scoliosis causes respiratory muscles weakness and reduced exercise capacity. However, the mechanism of these symptoms is still unknown. The main objective of this study was to determine the intensity of respiratory muscle activity and exercise capacity in patients with idiopathic scoliosis in comparison with healthy people. In this study, 20 female patients with adult idiopathic scoliosis (10 mild and 10 moderate) as well as 10 healthy matched individuals with characteristics of the patients were selected. The subjects were fatigued through a maximal incremental cycle ergometry protocol. Meanwhile, the electromyography values of the external intercostal muscles and diaphragm were recorded bilaterally, and fatigue duration was determined. The root mean square of concave external intercostal muscles and concave diaphragm in patients with idiopathic scoliosis was significantly reduced during the fatiguing exercise protocol compared with healthy individuals. The median frequencies of the two sides differed significantly and were lower in patients with moderate scoliosis than healthy subjects. Fatigue duration (minutes) also was lower in patients with moderate scoliosis than healthy subjects. Scoliosis causes respiratory muscle weakness and reduced fatigue duration in response to mild physical activity compared with healthy subjects and these dysfunctions appear to be related to the severity of scoliosis curvature (moderate > mild).

  12. Forces exerted during exercises by patients with adolescent idiopathic scoliosis wearing fiberglass braces.

    PubMed

    Romano, Michele; Carabalona, Roberta; Petrilli, Silvia; Sibilla, Paolo; Negrini, Stefano

    2006-07-21

    To quantify and compare the forces exerted by scoliosis patients in fiberglass braces during exercises usually prescribed in departments where casts are made. The exercises are intended to increase corrective forces, activate muscles, stimulate ventilation and help the patient psychologically. Outpatient care. 17 consecutive adolescent patients wearing fiberglass brace for idiopathic scoliosis. Exercises (kyphotization, rotation, "escape from the pad") in different positions (sitting, supine, on all fours). Pressure detected by the F-Socket System between the rib hump and the pad of the brace. In static and dynamic conditions, the position adopted did not alter the total pressure exerted by the brace, although the part of the sensor stimulated did vary. Kyphotization and rotation exercises produced a significant increase of pressure (+ 58.9% and +29.8%, respectively); however, the "escape from the pad" exercise, despite its name, did not produce any significant variation of pressure. Exercises in the brace allow adjunctive forces to be applied on soft tissues and through them, presumably on the spine. Different exercises can be chosen to obtain different actions. Physical exercises and sporting activities are useful in mechanical terms, although other important actions should not be overlooked.

  13. Association Between Sagittal Balance and Scoliosis in Patients with Parkinson Disease: A Cross-sectional Study.

    PubMed

    Bissolotti, Luciano; Donzelli, Sabrina; Gobbo, Massimiliano; Zaina, Fabio; Villafañe, Jorge Hugo; Negrini, Stefano

    2016-01-01

    The aim of this study was to describe the association between scoliosis and sagittal balance parameters in Parkinson disease patients. This is a cross-sectional study. Fifty percent of the cohort presented a scoliosis larger than 11 degrees; 84% of the patients with scoliosis presented a thoracolumbar curve, 10% presented a thoracic one, and 6% presented a lumbar one. The group with scoliosis curves presented a lower spinosacral angle (111.6 [21.9] degrees vs. 121.7 [9.8] degrees, P < 0.05), whereas thoracic kyphosis, lumbar lordosis, and spinopelvic angle were similar. Pelvic incidence, pelvic tilt, and sacral slope were not statistically different. In the scoliosis group, the authors found negative correlations for lumbar lordosis/spinopelvic angle, sacral slope/spinosacral angle, and lumbar lordosis/pelvic tilt. Moreover, the sacral slope/pelvic tilt correlation was positive in patients without scoliosis and negative in others. The two groups did not present differences regarding age, years of disease, Hoehn-Yahr score, and Unified Parkinson Disease Rating Scale-motor section. Pelvic parameters were similar in the two groups, whereas spinosacral angle was lower in patients with scoliosis. The prevalence of scoliosis in Parkinson disease was higher than what was previously described and the thoracolumbar spine was the mostly affected.

  14. Raster-stereographic evaluation of the effects of biomechanical foot orthoses in patients with scoliosis.

    PubMed

    Park, So Min; Ahn, Sang-Ho; Lee, A-Young; Park, In-Sik; Cho, Yun-Woo

    2016-07-01

    [Purpose] Little is known about the effects of biomechanical foot orthoses in scoliosis, as determined by raster stereography. The objective of this study was to investigate the effect of individually manufactured biomechanical foot orthoses on scoliosis angle, trunk imbalance, and pelvic obliquity by comparing them with general insoles by using DIERS formetric 4 dimensional in patients with scoliosis. [Subjects and Methods] Twenty-six patients with scoliosis were recruited at Yeungnam University Hospital and allocated equally to one of two groups, the biomechanical foot orthoses group or the control group. Parameters, such as, trunk rotation, imbalance, and scoliosis angle, were obtained using a DIERS formetric 4D. [Results] Scoliosis angle, pelvic obliquity, and trunk imbalance were significantly different between the two groups and improved in the biomechanical foot orthoses group with time, but no significant improvement in any parameter was observed in the control group. [Conclusion] Biomechanical foot orthoses could be effective in patients with scoliosis, and DIERS formetric 4D provides a useful method for evaluating scoliosis parameters.

  15. Raster-stereographic evaluation of the effects of biomechanical foot orthoses in patients with scoliosis

    PubMed Central

    Park, So Min; Ahn, Sang-Ho; Lee, A-Young; Park, In-Sik; Cho, Yun-Woo

    2016-01-01

    [Purpose] Little is known about the effects of biomechanical foot orthoses in scoliosis, as determined by raster stereography. The objective of this study was to investigate the effect of individually manufactured biomechanical foot orthoses on scoliosis angle, trunk imbalance, and pelvic obliquity by comparing them with general insoles by using DIERS formetric 4 dimensional in patients with scoliosis. [Subjects and Methods] Twenty-six patients with scoliosis were recruited at Yeungnam University Hospital and allocated equally to one of two groups, the biomechanical foot orthoses group or the control group. Parameters, such as, trunk rotation, imbalance, and scoliosis angle, were obtained using a DIERS formetric 4D. [Results] Scoliosis angle, pelvic obliquity, and trunk imbalance were significantly different between the two groups and improved in the biomechanical foot orthoses group with time, but no significant improvement in any parameter was observed in the control group. [Conclusion] Biomechanical foot orthoses could be effective in patients with scoliosis, and DIERS formetric 4D provides a useful method for evaluating scoliosis parameters. PMID:27512245

  16. Rotation of spinal curvatures of patients with structural scoliosis.

    PubMed

    Jaja, B N R; Didia, B C; Ekere, A U

    2008-04-01

    Scoliosis has obscure aetiopathogenesis and is underreported in our environment. To examine the pattern, magnitude, direction and extent of rotation of 42 structural curves in scoliotic patients. Plain radiographs of the spine in patients with scoliotic deformities were randomly selected from the film libraries of four Nigerian tertiary institutions.These were then assessed radiologically for the indices above, including the use of Cobbs method and the pedicle technique of Moe. In all, 14 thoracic and 28 thoracolumbar curves were evaluated. A double curve was identified in only one patient. Average age (range) of affected males was 31 (3-78) years and for females (n=25), it was 19.4 (3-40) years. Mean Cobb angle was 23.6 degrees (10 degrees-70 degrees) in males and 40.1 degrees (10 degrees-89 degrees) in females. In 29 (69%) of curves, angle magnitude was d" 30 degrees. Direction of spinal curvature was right convexity in 33 (78.6%) of evaluated curves while most curves 35 (84.4%) exhibited +1 vertebral rotation. Females present earlier than the males with a higher Cobb angles. Progression of curves appears to be a higher challenge in females. There is need for scoliosis surveillance programme for early diagnosis.

  17. Adolescent scoliosis patients. Personality patterns and effects of corrective surgery.

    PubMed

    Clayson, D; Levine, D B

    1976-05-01

    Personality patterns of 84 adolescent scoliosis patients were assessed and an evaluation made of certain psychological effects of corrective surgery. Results indicate the following: Scoliosis has fewer psychologically debilitating effects on younger adolescents (those under 16) than it does on older adolescents; scoliotic boys show comparatively better general personality integration than girls; scoliotic girls are less disturbed in psychosexual development than are boys. Postoperatively, boys can be expected to show less overt incapacitation than girls; psychologically, boys will require a longer period of recuperation than will girls; boys can be expected to present fewer immediate management problems than girls; the internalization of a sense of "difference" from the normal in adolescent scoliotics increases in direct relation to age. Consequently, the eariler surgical correction can be undertaken the better. Important differences exist between the psychological "set" of male and female adolescent patients. For boys, self-acceptance is at the core. Postoperative surgical care should thus focus on reinforcing characteristics of personal adequacy, namely, the ability to compete, and fulfill reasonable goals. For girls, acceptance by others is paramount. Postoperative care is best directed toward strengthening feelings of attractiveness (of any personal characteristic), worth, and, above all, future interpersonal possibilities.

  18. The prevalence of abnormal preoperative coagulation tests in pediatric patients undergoing spinal surgery for scoliosis.

    PubMed

    Ryan, Katie M; O'Brien, Kirsty; Regan, Irene; O'Byrne, John M; Moore, David; Kelly, Paula M; Noel, Jacques; Butler, Joseph; Nolan, Beatrice; Kiely, Patrick J

    2015-06-01

    Multilevel spinal fusion surgery for deformity correcting spinal surgery in pediatric patients with scoliosis has typically been associated with significant blood loss. The mechanism of bleeding in such patients is not fully understood. Coagulation abnormalities, which may be associated with scoliosis, are thought to play a role. To document and compare the prevalence of preoperative coagulation abnormalities among patients with scoliosis attending a pediatric orthopedic department for spinal fusion surgery with patients attending for minor surgery. An observational study. All patients were recruited from a pediatric tertiary referral center in Dublin, Ireland. Coagulation profile results were prospectively collected over a 2-year period from 165 spinal surgery patients. In total, 175 patients were included in the non-scoliosis group. These patients attended the day ward for minor procedures and were recruited over a 4-month period. The primary outcome measure was the coagulation profiles, which included prothrombin time, activated partial thromboplastin time (APTT), and thrombin time (TT). Levels of Coagulation Factors II, V, VII, and X were also recorded. All blood samples were sent to the haematology laboratory to establish the coagulation profile. The primary outcome was the presence of an abnormal coagulation screening test (if any of PT, APTT, or TT were abnormal). Prothrombin time, APTT, and TT were also analyzed as individual continuous variables, as well as Coagulation Factors II, V, VII, and X. Regression analysis was used to compare the coagulation profile of scoliosis patients with that of non-scoliosis patients. There were no outside funding sources or any potential conflict of interest associated with this study. The scoliosis patients were more likely to have an abnormal preoperative screening test compared with non-scoliosis patients, with an odds ratio of 2.6. Further analysis showed statistically significant longer clotting times for patients with

  19. Idiopathic scoliosis.

    PubMed

    Yaman, Onur; Dalbayrak, Sedat

    2014-01-01

    Scoliosis refers to curves exceeding 10 degrees observed through posterioanterior direct radiography. In fact, the diagnosis for idiopathic scoliosis is accepted to exclude already available causes. The aim of this paper was to review the etiopathogenesis, classification systems and the treatment management of idiopathic scoliosis. A search in the National Library of Medicine (Pubmed) database using the key words 'idiopathic' and 'scoliosis' was performed. For the literature review, papers concerning the etiopathogenesis, classification and treatment were selected among these articles. A search in the National Library of Medicine (Pubmed) database using the key words 'idiopathic' and 'scoliosis' yielded 4518 articles published between 1947 and 2013. The main hypothesis put forward included genetic factors, hormonal factors, bone and connective tissue anomalies. King, Lenke, Coonrad and Peking Union Medical College (PUMC) classifications were the main classification systems for idiopathic scoliosis. Exercise, bracing and anterior, posterior or combined surgery when indicated are the choices for the treatment. Every idiopathic scoliosis case has to be managed to its own characteristics. It is the post-operative appearance that the surgeons are perhaps the least interested but the adolescent patients the most interested in. The aim of scoliosis surgery is to restore the spine without neurological deficit.

  20. Scoliosis detection, patient characteristics, referral patterns and treatment in the absence of a screening program in Norway

    PubMed Central

    2012-01-01

    Background Early diagnosis of idiopathic scoliosis allows for observation and timely initiation of brace treatment in order to halt progression. School scoliosis screening programs were abolished in Norway in 1994 for lack of evidence that the programs improved outcome and for the costs involved. The consequences of this decision are discussed. Objectives To describe the detection, patient characteristics, referral patterns and treatment of idiopathic scoliosis at a scoliosis clinic during the period 2003–2011, when there was no screening and to compare treatment modalities to the period 1976–1988 when screening was performed. Methods Patient demographics, age at detection, family history, clinical and radiological charts of consecutive patients referred for scoliosis evaluation during the period 2003–2011, were prospectively registered. Patients were recruited from a catchment area of about 500000 teenagers. Maturity was estimated according to Risser sign and menarcheal status. Severity of pain was recorded by a verbal 5-point scale from no pain to pain at all times. Physical and neurological examinations were conducted. The detector and patient characteristics were recorded. Referral patterns of orthopedic surgeons at local hospitals and other health care providers were recorded. Patient data was obtained by spine surgeons. Treatment modalities in the current period were compared to the period 1976–1988. Results We registered 752 patients with late onset juvenile and adolescent idiopathic scoliosis from 2003–2011. There were 644 (86%) girls and 108 (14%) boys. Mean age at detection was 14.6 (7–19) years. Sixty percent had Risser sign ≥ 3, whilst 74% were post menarche with a mean age at menarche of 13.2 years. Thirty-one percent had a family history of scoliosis. The mean major curve at first consultation at our clinic was 38° (10°-95°). About 40% had a major curve >40°. Seventy-one percent were detected by patients, close relatives, and friends

  1. Pre- and postoperative photographs and surgical outcomes in patients with Lenke type 1 adolescent idiopathic scoliosis.

    PubMed

    Albayrak, Akif; Buyuk, Abdul Fettah; Ucpunar, Hanifi; Balioglu, Mehmet Bulent; Kargin, Deniz; Kaygusuz, Mehmet Akif

    2015-04-01

    Clinical study with pre- and postoperative back photographs and postoperative Scoliosis Research Society-22 survey in patients who had undergone surgery for idiopathic scoliosis. To determine the effect of showing patients their photographs before and after surgery for idiopathic scoliosis on postoperative patient satisfaction. After scoliosis surgery, patient satisfaction may be limited because the patients cannot directly see their back and may forget the preoperative appearance. In 60 patients who had undergone surgery for correction of idiopathic scoliosis (Lenke type 1), pre- and postoperative photographs were taken from the anterior, posterior, and right and left lateral views. After surgery, patients in group 1 (30 patients) were shown the preoperative and most recent follow-up photographs, and patients in group 2 (30 patients) had routine evaluation but were not shown their photographs. All patients completed the Scoliosis Research Society-22 survey. Patients in both groups had similar age, sex, distribution of Lenke type and Risser sign, follow-up, and pre- and postoperative Cobb angles and balance (coronal and sagittal). A significant difference was observed between the groups for survey question 10 (which was about self-image), question 18 (which was about function and activity), and question 21 (which was about satisfaction) (P ≤ 0.05). There were no differences between patients in groups 1 and 2 in Scoliosis Research Society-22 domain or total scores. By showing patients the pre- and postoperative clinical photographs, patient satisfaction may be greater, as measured with some SRS-22 scores. This method may enable clinicians to positively change the patients' self-image perception after surgery for correction of scoliosis. 4.

  2. Scoliosis Research Society

    MedlinePlus

    Scoliosis Research Society Close Menu Member Login Become a Member Home Find a Specialist | Calendar Contact | Donate Patients and Families Professionals ... Find a Specialist Calendar Contact Donate Scoliosis Research Society Dedicated to the optimal care of patients with ...

  3. Scoliosis in neuromuscular disorders.

    PubMed

    Pecak, F; Trontelj, J V; Dimitrijevic, M R

    1980-01-01

    Hundred-seventy patients with the 4 commonest degenerative neuro-muscular disorders (limbgirdle and Duchenne muscular dystrphy, Kugelberg-Welander's spinal muscular atrophy and peroneal muscular atrophy) were screened for scoliosis, which was found in 56%. Of 76 patients in the early stages of their respective disorders (stages 1-6 of Gardner-Medwin and Walton), scoliosis was found in 72%. The incidence of scoliosis was not related to the duration or degree of clinical weakness. Morphologically, scoliosis in these disorders was not found to differ from idiopathic scoliosis. Neither side nor site of the scoliosis were related to the distribution of muscle weakness as determined by manual testing.

  4. Converting Scoliosis Research Society-24 to Scoliosis Research Society-22r in a Surgical-Range, Medical/Interventional Adolescent Idiopathic Scoliosis Patient Cohort.

    PubMed

    Chen, Antonia F; Bi, Wenzhu; Singhabahu, Dilrukshika; Londino, Joanne; Hohl, Justin; Ward, Maeve; Ward, W Timothy

    2013-03-01

    Prospective questionnaire administration study. To assess the ability to translate total and domain scores from Scoliosis Research Society (SRS)-24 to SRS-22r in a surgical-range, medical/interventional adolescent idiopathic scoliosis (AIS) patient population. Conversion of SRS-24 to SRS-22r is demonstrated in an operative cohort of patients with AIS, but not in a medical/interventional patient population. We simultaneously administered SRS-24 and SRS-22r questionnaires to 75 surgical-range, medical/interventional AIS patients and compared them. We performed analysis by regression modeling to produce conversion equations from SRS-24 to SRS-22r. The total SRS-24 score for these medical/interventional AIS patients was 92.5 ± 9.45 (mean, 3.9 ± 0.39), and the total SRS-22r score was 93.5 ± 9.63 (mean, 4.3 ± 0.44). The correlation between these 2 groups was fair (R(2) = 0.77) and improved to good when mental health or recall questions were removed. The correlation was also fair for total pain domains (R(2) = 0.73). However, there was poor correlation for general self-image (R(2) = 0.6) and unacceptable for post-treatment self-image (R(2) = 0.01), general function (R(2) = 0.52), activity function (R(2) = 0.56), and satisfaction (R(2) = 0.53). Compared with a published population of operative AIS patients, R(2) values for total SRS-24 scores, pain, general self-image, activity function, and satisfaction were similar (p > .05). The R(2) values for general function and combined general and activity function were significantly different between the operative and medical/interventional cohorts. Scoliosis Research Society-24 can be converted to SRS-22r scores with fair accuracy in the surgical-range, medical/interventional AIS patient population for total score, and total pain domains. The SRS-24 translates unacceptably to the SRS-22r in self-image, function, and satisfaction domains. The SRS-24 to SRS-22r conversion equations are similar to operative AIS patients, except

  5. Predictive factors of Osaka Medical College (OMC) brace treatment in patients with adolescent idiopathic scoliosis.

    PubMed

    Kuroki, Hiroshi; Inomata, Naoki; Hamanaka, Hideaki; Higa, Kiyoshi; Chosa, Etsuo; Tajima, Naoya

    2015-01-01

    Factors influencing clinical course of brace treatment apply to adolescent idiopathic scoliosis (AIS) patients remain unclear. By making clear them, we may select suitable patients for brace treatment and alleviate overtreatment. The purpose of this study was to explore predictive factors of Osaka Medical College (OMC) brace treatment for AIS patients in accordance with the modified standardized criteria proposed by the Scoliosis Research Society (SRS) committee on bracing and non-operative management. From 1999 through 2010, 31 consecutive patients with AIS who were newly prescribed the OMC brace and met the modified SRS criteria were studied. The study included 2 boys and 29 girls with a mean age of 12 years and 0 month. We investigated the clinical course and evaluated the impacts of compliance, initial brace correction rate, curve flexibility, curve pattern, Cobb angle, chronological age, and Risser stage to clinical outcomes. The clinical course of the brace treatment was considered progression if ≥6° curvature increase occurred and improvement if ≥6° curvature decrease occurred according to SRS judgment criteria. The curve progressed in 10 cases, the curve improved in 6 cases, and the curve remained unchanged in 15 cases (success rate: 67.7%). The success rate was statistically higher in the patient group whose instruction adherence rate was greater than 50% as compared with in those 50% or less. Initial brace correction rate, curve flexibility, curve pattern, the magnitude of Cobb angle, chronological age, and Risser stage did not have any significant effect for clinical courses. However, success rate was insignificantly higher in the cases whose Cobb angle in brace was smaller than that in hanging position. OMC brace treatment could alter the natural history of AIS, however, that was significantly affected by compliance of brace wear.

  6. A Retrospective Study of Congenital Cardiac Abnormality Associated with Scoliosis

    PubMed Central

    Ucpunar, Hanifi; Sevencan, Ahmet; Balioglu, Mehmet Bulent; Albayrak, Akif; Polat, Veli

    2016-01-01

    Study Design Retrospective study. Purpose To identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatment for scoliosis. Overview of Literature Congenital and idiopathic scoliosis (IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwent surgical treatment for scoliosis. Methods Ninety consecutive scoliosis patients, who underwent surgical correction of scoliosis, were classified as CS (55 patients, 28 female [51%]) and IS (35 patients, 21 female [60%]). The complete data of the patients, including medical records, plain radiograph and transthoracic echocardiography were retrospectively assessed. Results We found that mitral valve prolapse was the most common cardiac abnormality in both patients with IS (nine patients, 26%) and CS (13 patients, 24%). Other congenital cardiac abnormalities were atrial septal aneurysm (23% of IS patients, 18% of CS patients), pulmonary insufficiency (20% of IS patients, 4% of CS patients), aortic insufficiency (17% of IS patients), atrial septal defect (11% of IS patients, 13% of CS patients), patent foramen ovale (15% of CS patients), dextrocardia (4% of CS patients), bicuspid aortic valve (3% of IS patients), aortic stenosis (2% of CS patients), ventricular septal defect (2% of CS patients), and cardiomyopathy (2% of CS patients). Conclusions We determined the increased incidence of congenital cardiac abnormalities among patients with congenital and IS. Mitral valve prolapse appeared to be the most prevalent congenital cardiac abnormality in both groups. PMID:27114761

  7. Characteristics and Clinical Relevance of the Osseous Spur in Patients with Congenital Scoliosis and Split Spinal Cord Malformation.

    PubMed

    Feng, Fan; Shen, Jianxiong; Zhang, Jianguo; Li, Shugang; Yu, Keyi; Tan, Haining

    2016-12-21

    The natural history of split spinal cord malformation (SCM) is still unclear. Knowledge of the characteristics of the osseous spur and its relationship with the spinal deformity may allow early identification of patients with a higher risk of a neurological deficit and enhance surgical decision-making. Eighty-five consecutive patients with congenital scoliosis and type-I SCM who had undergone surgical treatment at our hospital from May 2000 to December 2013 were identified retrospectively. There were 22 male and 63 female patients with an average age of 13.9 years at the time of surgery. Preoperative clinical and radiographic data were collected to investigate the characteristics of the scoliosis and the osseous spur. Two groups were identified on the basis of whether the patients had intact neurological function (Group A) or a neurological deficit (Group B). There were 52 patients (61%) in Group A (intact neurological function) and 33 patients (39%) in Group B (neurological deficit). There were no significant differences in the demographic distribution, curve magnitude, or length and thickness of the osseous spur between the 2 groups. In Group A, the location of the osseous spur relative to the apex of the major curve was proximal in 13 patients (25%), distal in 28 (54%), and central in 11 (21%). In Group B, the osseous spur was proximal in 7 (21%), distal in 8 (24%), and central in 18 (55%). The 2 groups differed significantly with respect to the location of the osseous spur (chi square = 10.898, p = 0.004). Group-B patients had a higher proportion of patients with kyphotic deformity (42%) than Group A (10%). The ratio of the diameters of the hemicords (concave side divided by convex side) differed significantly between the 2 groups (0.98 for Group A versus 0.89 for Group B, p = 0.030). The neurological status in patients with congenital scoliosis and type-I SCM appears to be closely related to the location of the osseous spur relative to the congenital scoliosis

  8. Progression of spinal deformity in wheelchair-dependent patients with Duchenne muscular dystrophy who are not treated with steroids: coronal plane (scoliosis) and sagittal plane (kyphosis, lordosis) deformity.

    PubMed

    Shapiro, F; Zurakowski, D; Bui, T; Darras, B T

    2014-01-01

    We determined the frequency, rate and extent of development of scoliosis (coronal plane deformity) in wheelchair-dependent patients with Duchenne muscular dystrophy (DMD) who were not receiving steroid treatment. We also assessed kyphosis and lordosis (sagittal plane deformity). The extent of scoliosis was assessed on sitting anteroposterior (AP) spinal radiographs in 88 consecutive non-ambulatory patients with DMD. Radiographs were studied from the time the patients became wheelchair-dependent until the time of spinal fusion, or the latest assessment if surgery was not undertaken. Progression was estimated using a longitudinal mixed-model regression analysis to handle repeated measurements. Scoliosis ≥ 10° occurred in 85 of 88 patients (97%), ≥ 20° in 78 of 88 (89%) and ≥ 30° in 66 of 88 patients (75%). The fitted longitudinal model revealed that time in a wheelchair was a highly significant predictor of the magnitude of the curve, independent of the age of the patient (p < 0.001). Scoliosis developed in virtually all DMD patients not receiving steroids once they became wheelchair-dependent, and the degree of deformity deteriorated over time. In general, scoliosis increased at a constant rate, beginning at the time of wheelchair-dependency (p < 0.001). In some there was no scoliosis for as long as three years after dependency, but scoliosis then developed and increased at a constant rate. Some patients showed a rapid increase in the rate of progression of the curve after a few years - the clinical phenomenon of a rapidly collapsing curve over a few months. A sagittal plane kyphotic deformity was seen in 37 of 60 patients (62%) with appropriate radiographs, with 23 (38%) showing lumbar lordosis (16 (27%) abnormal and seven (11%) normal). This study provides a baseline to assess the effects of steroids and other forms of treatment on the natural history of scoliosis in patients with DMD, and an approach to assessing spinal deformity in the coronal and

  9. Combined selective dorsal rhizotomy and scoliosis correction procedure in patients with cerebral palsy.

    PubMed

    Muquit, Samiul; Ammar, Amr; Nasto, Luigi; Moussa, Ahmad A; Mehdian, Hossein; Vloeberghs, Michael H

    2016-02-01

    Intrathecal baclofen (ITB) therapy for spasticity has been suggested to accelerate the development of scoliosis. We present the case of a 17-year-old female patient with cerebral palsy who had ITB therapy from the age of 11 years. During this period, she developed a severe scoliosis measuring 86° from T11 to L4, with pain due to costo-pelvic impingement. Her baclofen pump had reached its end of life and required replacement if ITB therapy was to continue. This coincided with plans for scoliosis corrective surgery. We performed scoliosis correction along with removal of baclofen pump and selective dorsal rhizotomy (SDR), as a single combined procedure. SDR was performed instead of ITB pump replacement for management of spasticity. Following surgery, scoliosis improved to 24°. At 6 month follow-up, there was significant improvement in spasticity and quality of life. This report illustrates the feasibility of a combined procedure to correct scoliosis and manage spasticity with SDR. We present the case details, our management and review of the published literature regarding the factors influencing treatment of scoliosis and spasticity.

  10. Height velocity curves in female patients with idiopathic scoliosis.

    PubMed

    Chazono, Masaaki; Soshi, Sigeru; Kida, Yoshikuni; Hashimoto, Kurando; Inoue, Takeshi; Nakamura, Yousuke; Shinohara, Akira; Marumo, Keishi; Kono, Katsuki; Suzuki, Nobumasa

    2012-01-01

    Following identification of peak height velocity (PHV) by a recent study as a possible prognostic factor for curve progression in patients with idiopathic scoliosis (IS), the aim of this study was to investigate PHV curves in Japanese female patients with IS. The study subjects were 20 skeletally immature IS patients who were followed until maturity. The mean age and the mean pubertal status at the initial visit were 9.8 years and 24 months before menarche, respectively, with a follow-up period of 5.2 years. Height measurements were recorded at each visit, and HV was calculated as the change in height (cm) divided by the time interval (yr.) between visits of 6 to 12 months. The PHV, age at PHV (APHV), height at PHV (HPHV), and final height (FH) were determined. Patient HV curves were plotted using their HV data, and growth periods (GPs) were calculated from the curves. PHVs and GPs of study patients were compared to standard data from unaffected girls. The median values and interquartile ranges in PHV, APHV, HPHV, and FH were 8.5 cm/yr. (7.9-9.7), 11.8 yr. (11.2-12.1), 153.2 cm (150.1-155.8), and 160.1 cm (157.4-162.4), respectively. The median GP was 27 months. The PHV and GP values in IS female patients were higher and shorter than those in unaffected girls. These findings indicate that the patterns of height velocity curves in IS patients are different from those in unaffected girls, suggesting that curve progression in IS patients is associated with the magnitude of PHV and duration of GP. Recently, we have developed an HV reader to easily and quickly identify the present HV in patients with scoliosis, applicable for the clinical setting or school screening. We conclude that risk assessments of curve progression in patients with IS should include HV along with measures of skeletal maturity such as the Risser sign and/or digital skeletal age using hand X-rays.

  11. Prospective evaluation of physical activity in patients with idiopathic scoliosis or kyphosis receiving brace treatment.

    PubMed

    Müller, Carsten; Fuchs, Katharina; Winter, Corinna; Rosenbaum, Dieter; Schmidt, Carolin; Bullmann, Viola; Schulte, Tobias L

    2011-07-01

    Bracing is an established method of conservative treatment for adolescent idiopathic scoliosis and kyphosis. Compliance among adolescents is frequently inadequate due to the discomfort of wearing a brace, cosmetic issues, and fear on the part of patients and parents that bracing may reduce everyday physical activities. The aim of this prospective, controlled study was to objectify the impact of spinal bracing on daily step activity in patients receiving conservative treatment for adolescent idiopathic scoliosis (AIS) or adolescent kyphosis (AK). Forty-eight consecutive patients (mean age 13.4 ± 2.3 years), consisting of 38 AIS patients (33 girls, 5 boys) and 10 AK patients (6 girls, 4 boys) were included. Once the decision to carry out bracing had been taken and while the patients were waiting for the individual brace to be built, step activity was assessed without braces by means of step activity monitoring (SAM) for seven consecutive days. After 8 weeks of brace wearing, step activity was assessed during regular brace treatment, again for seven consecutive days. In addition, brace-wearing times were simultaneously recorded using temperature probes implanted in the braces to measure compliance. Before and during brace treatment, patients completed the Scoliosis Research Society (SRS-22) questionnaire. The SAM was worn for an average of 12.7 ± 1.5 h/day during the first measurement and 12.3 ± 1.9 h on average during the second measurement. The mean gait cycles (GCs) per day and per hour before treatment were 5,036 ± 1,465 and 395 ± 105, respectively. No significant reduction in step activity was found at the follow-up measurement during bracing, at 4,880 ± 1,529 GCs/day and 403 ± 144 GCs/h. Taking the 23-h recommended time for brace wearing as a basis (100%), patients wore the brace for 72.7 ± 27.6% of the prescribed time, indicating an acceptable level of compliance. Girls showed a higher compliance level (75.6 ± 25.6%) in comparison with boys (56.7 ± 31

  12. Intensive care unit versus hospital floor: a comparative study of postoperative management of patients with adolescent idiopathic scoliosis.

    PubMed

    Shan, Le-Qun; Skaggs, David L; Lee, Christopher; Kissinger, Catherine; Myung, Karen S

    2013-04-03

    Patients undergoing posterior spinal instrumentation and fusion surgery for adolescent idiopathic scoliosis were admitted to the intensive care unit until two years ago, at which time we changed our protocol to admit these patients to the general hospital floor following a brief stay in a postanesthesia care unit. This study compared postoperative management on a hospital floor with that in the intensive care unit for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. A retrospective review of 124 consecutive patients with adolescent idiopathic scoliosis treated with spinal fusion from August 2007 to August 2010 was performed. Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis and posterior spinal instrumentation and fusion surgery. Of 124 patients, sixty-six were managed postoperatively in the intensive care unit and fifty-eight, on the hospital floor. The mean age at the time of surgery was fourteen years. A mean of eleven vertebral levels (range, six to fifteen levels) were fused. No significant difference between the groups was found with respect to the mean age at the time of surgery, mean weight, mean preoperative and postoperative Cobb angles, and mean number of levels fused (p ≥ 0.12). However, the use of analgesic and antianxiety medication, number of postoperative blood tests, days of hospital stay, and number of physical therapy sessions were significantly decreased in the floor group compared with the intensive care unit group (p ≤ 0.05). No patient from the floor group had to be admitted to the intensive care unit. The mean charge was $33,121 for the floor group and $39,252 for the intensive care unit group (p < 0.001). Initial postoperative management of patients with adolescent idiopathic scoliosis following a posterior spinal instrumentation and fusion surgery on a general hospital floor, rather than in an intensive care unit, was associated with a shorter hospital stay, fewer blood tests, less

  13. [Autoimmune hepatitis and pregnancy: about a patient's three consecutive pregnancies].

    PubMed

    Rivoire, C; Houlle, C; Bonnin, M; Cotte, B; Bolandard, F; Nohuz, E; Jardon, K; Rabischong, B; Canis, M; Mage, G

    2008-03-01

    Spontaneous evolution of autoimmune hepatitis during pregnancy is not well known, nor are its consequences on pregnancy evolution. Immunosuppressive treatment during pregnancy is sometimes necessary but the long- and short-term consequences are unrecognized. We relate a patient's disease with autoimmune hepatitis and cirrhosis and three consecutive pregnancies with different obstetrical and medical complications.

  14. Evaluation of Patient Outcome and Satisfaction after Surgical Treatment of Adolescent Idiopathic Scoliosis Using Scoliosis Research Society-30.

    PubMed

    Ghandehari, Hasan; Mahabadi, Maryam Ameri; Mahdavi, Seyed Mani; Shahsavaripour, Ali; Seyed Tari, Hossein Vahid; Safdari, Farshad

    2015-04-01

    Adolescent idiopathic scoliosis (AIS) may lead to physical and mental problems. It also can adversely affect patient satisfaction and the quality of life. In this study, we assessed the outcomes and satisfaction rate after surgical treatment of AIS using scoliosis research society-30 questionnaire (SRS-30). We enrolled 135 patients with AIS undergoing corrective surgery. Patients were followed for at least 2 years. We compared pre- and post-operative x-rays in terms of Cobb's angles and coronal balance. At the last visit, patients completed the SRS-30 questionnaire. We then assessed the correlation between radiographic measures, SRS-30 total score, and patient satisfaction. Cobb's angle and coronal balance improved significantly after surgery (P<0.001). The scores of functional activity, pain, self-image/cosmesis, mental health, and satisfaction were 27±4.3, 26±2.5, 33±5.2, 23±3.5, and 13±1.8, respectively. The total SRS-30 score was 127±13. Radiographic measures showed significant positive correlation with satisfaction and SRS-30 total scores. There was also a positive correlation between satisfaction and self-image/cosmesis domain scores. The greater the radiographic angles were corrected the higher the SRS-30 total score and patient satisfaction were. It is intuitive that the appearance and cosmesis is of most important factor associated with patient satisfaction.

  15. Score distribution of the scoliosis research society-22 questionnaire in subgroups of patients of all ages with idiopathic scoliosis.

    PubMed

    Parent, Eric C; Dang, Rohan; Hill, Doug; Mahood, Jim; Moreau, Marc; Raso, Jim; Lou, Edmond

    2010-03-01

    Cross-sectional measurement study. To analyze the score distribution of the Scoliosis Research Society (SRS)-22 questionnaire domains and items for patients with idiopathic scoliosis (IS) of all ages. Scoliosis-related quality-of-life questionnaires have demonstrated high ceiling effects in younger patients. However, the score distribution has not been examined thoroughly in other clinically relevant IS subgroups. The SRS-22 was completed by 173 females with IS. The proportions of ceiling effects, floor effects, of patients scoring greater than or equal to 4 out of 5 and the box plots of the score distribution for each domain and item were compared between subgroups. Subgroups were formed based on age (k = 4), management (k = 6), curve severity (k = 3), and curve type (k = 4). Domain ceiling effects varied between 0% and 23.1%. Domain floor effects were observed only for Self-image (<7%) and Satisfaction (<12%). Only Pain and Satisfaction showed moderate (>20%) ceiling effects. Ceiling effects for Pain and Mental Health decreased with increasing age (P < 0.05). Pain ceiling effects decreased and Satisfaction ceiling effects increased from least to most invasive management (P < 0.05), but no differences were found among Cobb severity or curve types subgroups. Of the 22 items, 9 had major (>or=50%) ceiling effects and 11 had moderate ceiling effects. Most subgroups (14/16) had 4 to 6 items with major ceiling effects. The following items had major ceiling effects in the majority of subgroups: Function, 9 and 15; Pain, 11 and 17; and Self-image, 14. Most SRS-22 domains had acceptable levels of ceiling effects (<20%) in the majority of the subgroups examined. However, more sensitive measurements may be needed to supplement the SRS-22 in assessing Pain in patients below 18 years or Satisfaction after surgery.

  16. The influence of body image on surgical decisions in adolescent idiopathic scoliosis patients.

    PubMed

    Borges, Paulo Alvim; Carvalho, José Thomé de; Letaif, Olavo Biraghi; Marcon, Raphael Martus; Cristante, Alexandre Fogaça

    2017-03-01

    The objective of this study was to evaluate whether the severity of deformities in patients with adolescent idiopathic scoliosis contributes to patients' decision regarding whether to undergo an operation. We evaluated body image factors in adolescent idiopathic scoliosis patients. We evaluated the magnitude of the main scoliotic curve, gibbosity (magnitude and location), shoulder height asymmetry and patient's age. We analyzed the correlation of these data with the number of years the patient was willing to trade for surgery, as measured by the time-trade-off method. A total of 52 patients were studied. We did not find a correlation between any of the parameters that were studied and the number of years that the patient would trade for the surgery. The magnitude of body deformities in patients with adolescent idiopathic scoliosis does not interfere with the decision to undertake surgical treatment.

  17. A Moyamoya Patient with Bilateral Consecutive Branch Retinal Vein Occlusion

    PubMed Central

    Güçlü, Hande; Gurlu, Vuslat Pelitli; Ozal, Sadık Altan; Esgin, Haluk

    2016-01-01

    ABSTRACT We describe a moyamoya (MMD) patient with bilateral consecutive branch retinal vein occlusion (BRVO). The patient had a medical history of severe headache, cranial haemorrhage, bilateral supraclinoid carotid artery occlusion, and “puff of smoke” collaterals on cerebral angiography and an encephalomyosynangiosis operation. On ophthalmic examination, he had superior temporal branch vein occlusion with intraretinal haemorrhage and visual acuity of 20/25 in the right eye. Twelve years later, he presented with superior temporal branch vein occlusion in the left eye and visual acuity of 20/60. The patient was initially treated with a dexamethasone intravitreal implant, and later intravitreal ranibizumab injections. We describe the first reported case of bilateral consecutive BRVO and management in MMD. PMID:27928391

  18. Shoulder balance after surgery in patients with Lenke Type 2 scoliosis corrected with the segmental pedicle screw technique.

    PubMed

    Li, Ming; Gu, Suxi; Ni, Jianqiang; Fang, Xiutong; Zhu, Xiaodong; Zhang, Zhiyu

    2009-03-01

    The authors evaluated the effectiveness of Lenke Type 2 criteria in scoliosis correction with the segmental pedicle screw (PS) technique, with emphasis on shoulder balance. Twenty-five consecutive patients with Lenke Type 2 scoliosis (structural double thoracic curves, sidebending Cobb angle > 25 degrees , or T2-5 kyphosis > 20 degrees ) who underwent segmental PS instrumentation were included in this study. At surgery, the patients were an average of 14.1 years of age, and the average duration of follow-up was 2.9 years. For radiological evaluation of the patients, preoperative, postoperative, and the latest available follow-up radiographs were used. The difference between right and left shoulder heights was determined to assess shoulder balance. All patients were treated with fusion of both the proximal and distal curves. The mean preoperative proximal thoracic curve of 43 degrees was corrected to 21 degrees postoperatively, a 51.2% correction. The preoperative lower thoracic curve of 61 degrees was corrected to 23 degrees , for a 62.3% correction. The preoperative shoulder height difference of -5.92 +/- 12.52 mm (range: -31 to +14 mm, negative designating a lower left shoulder) was improved to 1.52 +/- 8.12 mm. Postoperatively, no patient had significant or moderate shoulder imbalance, 4 patients had minimal shoulder imbalance, and 21 patients had balanced shoulders. Although Lenke Type 2 criteria were developed wth Cotrel-Dubousset instrumentation, they are successfully applied to determining thoracic fusion when segmental PS instrumentation is used.

  19. Vertebral Body Stapling versus Bracing for Patients with High-Risk Moderate Idiopathic Scoliosis

    PubMed Central

    Cuddihy, Laury; Danielsson, Aina J.; Cahill, Patrick J.; Samdani, Amer F.; Grewal, Harsh; Richmond, John M.; Mulcahey, M. J.; Gaughan, John P.; Antonacci, M. Darryl; Betz, Randal R.

    2015-01-01

    Purpose. We report a comparison study of vertebral body stapling (VBS) versus a matched bracing cohort for immature patients with moderate (25 to 44°) idiopathic scoliosis (IS). Methods. 42 of 49 consecutive patients (86%) with IS were treated with VBS and followed for a minimum of 2 years. They were compared to 121 braced patients meeting identical inclusion criteria. 52 patients (66 curves) were matched according to age at start of treatment (10.6 years versus 11.1 years, resp. [P = 0.07]) and gender. Results. For thoracic curves 25–34°, VBS had a success rate (defined as curve progression <10°) of 81% versus 61% for bracing (P = 0.16). In thoracic curves 35–44°, VBS and bracing both had a poor success rate. For lumbar curves, success rates were similar in both groups for curves measuring 25–34°. Conclusion. In this comparison of two cohorts of patients with high-risk (Risser 0-1) moderate IS (25–44°), in smaller thoracic curves (25–34°) VBS provided better results as a clinical trend as compared to bracing. VBS was found not to be effective for thoracic curves ≥35°. For lumbar curves measuring 25–34°, results appear to be similar for both VBS and bracing, at 80% success. PMID:26618169

  20. Simple methods to reduce patient exposure during scoliosis radiography

    SciTech Connect

    Butler, P.F.; Thomas, A.W.; Thompson, W.E.; Wollerton, M.A.; Rachlin, J.A.

    1986-05-01

    Radiation exposure to the breasts of adolescent females can be reduced significantly through the use of one or all of the following methods: fast, rare-earth screen-film combinations; specially designed compensating filters; and breast shielding. The importance of exposure reduction during scoliosis radiography as well as further details on the above described methods are discussed. In addition, the early results of a Center for Devices and Radiological Health study, which recorded exposure and technique data for scoliosis radiography, is presented.

  1. The left thoracic curve pattern: a strong predictor for neural axis abnormalities in patients with "idiopathic" scoliosis.

    PubMed

    Wu, Liang; Qiu, Yong; Wang, Bin; Zhu, Ze Zhang; Ma, Wei Wei

    2010-01-15

    A prospective trial of MRI study in patients with "idiopathic" left thoracic scoliosis. To investigate the prevalence of neural axis abnormalities in asymptomatic patients with "idiopathic" left thoracic scoliosis. Some patients with neural axis abnormalities have scoliosis as the only presenting sign, and they might be given a diagnosis of "idiopathic" scoliosis. These neural axis abnormalities are risk factors for neurologic injury during spine correction. With the development of MRI, neural axis abnormalities are increasingly being found in patients with "idiopathic" scoliosis. However, there are few reports on the prevalence of neural axis abnormalities in asymptomatic patients with "idiopathic" left thoracic scoliosis. A total of 68 patients with presumed "idiopathic" left thoracic scoliosis were examined for neural axis abnormalities, using MRI. Neural axis abnormalities were detected in 37 (54%) patients, including Chiari 1 malformation in 15 patients, Chiari 1 malformation with syringomyelia in 10, Chiari 1 malformation with syringomyelia and tethered cord in 1, Chiari 1 malformation with syringomyelia and diastematomyelia in 1, syringomyelia in 8, syringomyelia with tethered cord in 1, and arachnoidal cyst in cerebellomedullary cistern in 1 patient. There were statistically significant differences between patients with and without neural axis abnormalities regarding gender and curve severity (P < 0.05). When a left thoracic curve pattern is present in patients with "idiopathic" scoliosis, especially in male patients or patients with severe curve, strong consideration should be given to the possibility of the presence of neural axis abnormalities, and acquisition of an MRI scan considered.

  2. Prevalence of scoliosis in Williams-Beuren syndrome patients treated at a regional reference center

    PubMed Central

    Damasceno, Marcelo Loquette; Cristante, Alexandre Fogaça; Marcon, Raphael Martus; de Barros Filho, Tarcísio Eloy Pessoa

    2014-01-01

    OBJECTIVE: This study assessed the prevalence of scoliosis and the patterns of scoliotic curves in patients with Williams-Beuren syndrome. Williams-Beuren syndrome is caused by a chromosome 7q11.23 deletion in a region containing 28 genes, with the gene encoding elastin situated approximately at the midpoint of the deletion. Mutation of the elastin gene leads to phenotypic changes in patients, including neurodevelopmental impairment of varying degrees, characteristic facies, cardiovascular abnormalities, hypercalcemia, urological dysfunctions, and bone and joint dysfunctions. METHODS: A total of 41 patients diagnosed with Williams-Beuren syndrome, who were followed up at the genetics ambulatory center of a large referral hospital, were included in the study. There were 25 male subjects. The patients were examined and submitted to radiographic investigation for Cobb angle calculation. RESULTS: It was observed that 14 patients had scoliosis; of these 14 patients, 10 were male. The pattern of deformity in younger patients was that of flexible and simple curves, although adults presented with double and triple curves. Statistical analysis showed no relationships between scoliosis and age or sex. CONCLUSION: This study revealed a prevalence of scoliosis in patients with Williams-Beuren syndrome of 34.1%; however, age and sex were not significantly associated with scoliosis or with the severity of the curves. PMID:25029575

  3. The influence of body image on surgical decisions in adolescent idiopathic scoliosis patients

    PubMed Central

    Borges, Paulo Alvim; de Carvalho Neto, José Thomé; Letaif, Olavo Biraghi; Marcon, Raphael Martus; Cristante, Alexandre Fogaça

    2017-01-01

    OBJECTIVES: The objective of this study was to evaluate whether the severity of deformities in patients with adolescent idiopathic scoliosis contributes to patients’ decision regarding whether to undergo an operation. METHODS: We evaluated body image factors in adolescent idiopathic scoliosis patients. We evaluated the magnitude of the main scoliotic curve, gibbosity (magnitude and location), shoulder height asymmetry and patient’s age. We analyzed the correlation of these data with the number of years the patient was willing to trade for surgery, as measured by the time-trade-off method. RESULTS: A total of 52 patients were studied. We did not find a correlation between any of the parameters that were studied and the number of years that the patient would trade for the surgery. CONCLUSIONS: The magnitude of body deformities in patients with adolescent idiopathic scoliosis does not interfere with the decision to undertake surgical treatment. PMID:28355357

  4. Why do idiopathic scoliosis patients participate more in gymnastics?

    PubMed

    Meyer, C; Cammarata, E; Haumont, T; Deviterne, D; Gauchard, G C; Leheup, B; Lascombes, P; Perrin, Ph P

    2006-08-01

    The influence of physical and sporting activities (PSA) on idiopathic scoliosis (IS) is still obscure. The aim of this study was to investigate whether such an influence exists and if so, to determine its characteristics. Two hundred and one teenagers with IS and a control group of 192 adolescents completed an epidemiological questionnaire. Those practising gymnastics were more numerous in the IS group than in the control group. Moreover, the practice of gymnastics was chosen before IS was diagnosed. As gymnastic activities are considered neither as a therapy nor as a precursor of IS, the distribution observed could be linked to a common factor that both increases the likelihood of IS and favors the practice of gymnastics. Joint laxity (JL) may be such a common factor, and was therefore tested (wrist and middle finger) on 42 girls with IS and 21 girls of a control group. IS patients, practising gymnastics or not, showed a higher JL than the control group practising gymnastics or not. Furthermore, the groups practising gymnastic activities did not show higher JL levels than the other groups. Children with a high JL could be drawn toward gymnastics because of their ability to adapt to the constraints of this sport. Girls with a high JL may therefore be prone to developing IS. The fact that most teenagers with IS practise gymnastics could be related to a higher JL.

  5. Scoliosis research society-22 patient questionnaire: responsiveness to change associated with surgical treatment.

    PubMed

    Asher, Marc; Min Lai, Sue; Burton, Doug; Manna, Barbara

    2003-01-01

    Prospective observational consecutive case series. To determine the responsiveness to change of the Scoliosis Research Society-22 (SRS-22) patient questionnaire after surgical treatment. The SRS-22 outcomes questionnaire is the outgrowth of prior research that led to modifications and improvements of the original SRS questionnaire. Fifty-eight patients with an average age of 16 years and an average Cobb size of 63 degrees enrolled. They were tested preoperatively and at 3- (within 4 months), 6- (5-8 months), 12- (9-16 months), and 24-month (22-36 months) intervals postoperatively using the SRS-22 outcomes questionnaire. The paired Student test with multiple comparison adjustment was used to test significance of change score over time. Only patients with data on both time points of interest were included in the analysis. Self-image was significantly improved at 3 months ( < 0.0001) and maintained improvement through 24 months. Function was significantly decreased at 3 months ( < 0.0001), but returned to baseline by 6 months. Pain was significantly worse at 3 months ( = 0.0099), but was significantly less at 6 ( = 0.0011), 12 ( < 0.0001), and 24 ( = 0.0037) months when compared to 3 months. The SRS-22 questionnaire is responsive to changes in the postsurgical period.

  6. Coagulation Profile of Patients with Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion.

    PubMed

    Bosch, Patrick; Kenkre, Tanya S; Londino, Joanne A; Cassara, Antonio; Yang, Charles; Waters, Jonathan H

    2016-10-19

    Blood loss and transfusion requirements during posterior spinal fusion for adolescent idiopathic scoliosis remain a concern. The mechanism of bleeding in these patients is poorly characterized. Thromboelastography is a comprehensive test of a patient's coagulation system commonly used in cardiac surgical procedures. It has not been well studied for use in patients with adolescent idiopathic scoliosis. A prospective, observational study of the coagulation profile of patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion is presented. Healthy patients with adolescent idiopathic scoliosis without a bleeding abnormality were analyzed during posterior spinal fusion. Standard coagulation laboratory and thromboelastogram measures were obtained at the time of the incision and at 1-hour intervals during the surgical procedure. Laboratory values were analyzed in relation to outcomes such as bleeding, transfusion, and a fibrinolysis score. Fifty-eight patients were observed. Eighty-one percent of patients were female, the mean age was 13.5 years, a mean of 11.1 levels were fused, the median estimated blood loss was 645 mL, and 47% of patients received blood products. Overall, laboratory values remained stable throughout the surgical procedure. Mild increases in prothrombin time and partial thromboplastin time were observed, and platelets remained stable. From thromboelastogram analysis, an acceleration of clot formation (decreased reaction time) and a slight increase in clot lysis (increased lysis percentage at 30 minutes) were observed. A fibrinolysis score compiled from the presence of fibrin degradation products, the presence of D-dimers, and increased prothrombin time rose steadily over surgical time. The fibrinolysis score was predictive of both transfusion and greater estimated blood loss per level. The stress of posterior spinal fusion induces a hypercoagulable state in patients with adolescent idiopathic scoliosis. Over the first 2 hours of a

  7. Psychological Evaluations of Patients Operated for Idiopathic Scoliosis by the Harrington Method.

    ERIC Educational Resources Information Center

    Orvomaa, E.

    1998-01-01

    A study of 204 patients operated on for idiopathic scoliosis by the Harrington method between 1970 and 1975 found that patients were content with their lives, tended to form families later in life, and had fewer sexual relationships. The patients felt their illness had mostly influenced their participation in work and in physical activities.…

  8. Conventional metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis: a comparative study

    SciTech Connect

    Pettersson, H.; Harwood-Nash, D.C.; Fitz, C.R.; Chuang, H.S.; Armstrong, E.

    1982-01-01

    A retrospective examination was performed to assess the accuracy of metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis. Of 81 consecutive scoliotic children studied by myelography, 30 had only MM while the remaining 51 had CTMM immediately afterward. CTMM added esential diagnostic information in 13 cases of dysraphism and 4 cases, both methods gave the same imformation. The outhors conclude that in patients with severe scoliosis, dysraphism, and scoliosis with localized neurological disturbances, CTMM should always be added to MM or be the only examination; while in idiopathic scoliosis with vague neurological disturbances a survey of the entire spine is essential, preferably with MM.

  9. Congenital scoliosis.

    PubMed

    Kose, Nusret; Campbell, Robert M

    2004-05-01

    The management of congenital scoliosis requires a systematic approach with careful attention to detail. Any fortuitous diagnosis of vertebral anomalies in infancy, even if there is no significant scoliosis at that time on x-ray, requires frequent clinical and radiographic follow-up to detect progression. The presence of associated anomalies of the spinal cord, the kidneys and the heart should be evaluated by MRI, renal ultrasound or IVP, with cardiology evaluation as indicated. Curve progression or severe vertebral anomalies known to cause curve progression require immediate treatment to prevent deformity. Significant thoracic deformity, especially in a patient with thoracic insufficiency syndrome, is best treated with expansion thoracoplasty. The patient with congenital scoliosis requires a long term commitment to care with frequent orthopaedic follow-up throughout the growing years along with routine pulmonary function assessment once the patient is able to cooperate with testing.

  10. Improving education and coping of scoliosis patients undergoing surgery, and their families, using e-health.

    PubMed

    Lysenko, Magdalena; Law, Peggy; Jarvis, James; Wright, James G

    2016-12-01

    Healthcare providers have limited time to spend with scoliosis patients who are considering surgery and their families. The purpose of this study was to evaluate an e-health strategy to increase knowledge and coping in patients with scoliosis who are surgical candidates and their families. We enrolled patients with scoliosis who were candidates for surgery and their families. Patients and their families completed the scoliosis knowledge questionnaire, meaning of illness questionnaire, social support and coping questionnaires before and after access to a comprehensive evidence-based scoliosis website ( http://www.aboutkidshealth.ca/scoliosis ). Seventy-four patients and 71 parents completed the evaluation. While both patients and parents improved their knowledge of scoliosis (p = 0.001 and p = 0.003, respectively), the scores of patients were consistently lower than those of the parents both before and after website use (p = 0.0001). Only parents demonstrated a change in the meaning of illness questionnaire, with a small increase in the negative attitude towards illness and a small decrease in the positive attitude towards illness (p = 0002 and p = 0.01, respectively). Of the 12 coping methods examined on the Adolescent Coping Orientation for Problem Experiences (A-COPE) instrument, patients were slightly more likely than parents to use relaxing and solving family problems as tools to cope following website access (p = 0.02 and p = 0.09, respectively). Parents demonstrated no significant changes in the four methods of coping on the Coping Health Inventory for Parents (CHIP) after website exposure. While the majority of patients and parents reported receiving sufficient support, over half of the patients indicated a need for more support in social participation. An evidence-based website increased the knowledge of patients and parents but simply providing access to the website had minimal impact on their coping and perceptions of social support. The

  11. Scoliosis in patients with Prader Willi Syndrome – comparisons of conservative and surgical treatment

    PubMed Central

    Weiss, Hans-Rudolf; Goodall, Deborah

    2009-01-01

    In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS. Types of participants included: patients with scoliosis and PWS. Type of intervention: surgery. Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles. Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70° and some of which improved. If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients

  12. Scoliosis in patients with Prader Willi Syndrome - comparisons of conservative and surgical treatment.

    PubMed

    Weiss, Hans-Rudolf; Goodall, Deborah

    2009-05-06

    In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS.Types of participants included: patients with scoliosis and PWS.Type of intervention: surgery.Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles.Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70 degrees and some of which improved. If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients

  13. Scoliosis (For Parents)

    MedlinePlus

    ... of scoliosis helps health care providers treat it. Idiopathic scoliosis . This is the most common type of scoliosis. ... Spinal Fusion Surgery Preparing Your Child for Surgery Idiopathic Scoliosis Scoliosis Word! Scoliosis Scoliosis Kyphosis Can Scoliosis Affect ...

  14. Secondary scoliosis after thoracotomy in patients with aortic coarctation and patent ductus arteriosus.

    PubMed

    Roclawski, Marek; Pankowski, Rafal; Smoczynski, Andrzej; Ceynowa, Marcin; Kloc, Wojciech; Wasilewski, Wojciech; Jende, Piotr; Liczbik, Wieslaw; Beldzinski, Piotr; Libionka, Witold; Pierzak, Olaf; Adamski, Stanislaw; Niedbala, Miroslaw

    2012-01-01

    The aim of this study was to determine the influence of lateral thoracotomy on the development of scoliosis in subjects undergoing repair of coarctation of the aorta (CoAo) and patent ductus arteriosus (PDA). A group of 133 patients with CoAo and PDA was evaluated. Forty-five patients with CoAo and 38 with PDA were operated on using lateral thoracotomy (operative group) while 12 patients with CoAo and 31 with PDA were treated using balloon dilatation and stent or coil implantation (non-operative group). Clinical examination and the evaluation of spinal roentgenograms were performed. Among the operated patients 46.6% of those with CoAo and 39.5% of those with PDA had clinical scoliosis. In the non-operated patients scoliosis was present in only 16.6% of those with CoAo and 12.9% of those with PDA. Scoliosis ranged between 10° and 42° and it was mild in the majority of cases. In 90.4% of the operated scoliotic patients with CoAo and 73.3% of those with PDA the curve was thoracic and in 47.6% of the CoAo group and 53,3% of the PDA group the curve was left sided. All curves were right sided in non-operated subjects. Scoliosis in the operated group was higher in males than in females (63.3% versus 60% in CoAo and 68.2% versus 37.5% in PDA). The prevalence of scoliosis after thoracotomy was significantly higher than after non-surgical methods of treatment of both CoAo and PDA as well as in the general population. The rate of single thoracic and the rate of left thoracic curves in patients after thoracotomy is higher than in patients treated non-surgically or in idiopathic scoliosis. The rate of scoliosis after thoracotomy is higher in males than females especially following thoracotomy for PDA.

  15. Sudden death in a patient with idiopathic scoliosis.

    PubMed

    Satoh, Fumiko; Fujita, Masaki Q; Seto, Yoshihisa; Tsuboi, Akio; Takeichi, Sanae

    2006-01-01

    We report an autopsy case of sudden death in a 36-year-old craftsman with idiopathic scoliosis. The doctor identified his scoliosis at the age of thirteen, and he was under medical care for three years until he stopped consulting the doctor. He collapsed while walking at the station and was sent to an emergency room in cardiopulmonary arrest state, where he was declared dead in spite of more than an hour of CPR. Numbers of petechiae were seen on the bilateral palpebral conjunctivae and the lips were cyanotic. There were no particular injuries except for small abrasions observed on the face. The back showed right rib hump owing to midthoracic scoliosis (with 73 degrees of Cobb's angle) and right hemithorax was deformed showing an appearance of pectus excavatum in the front. The volume of the right thoracic cavity was significantly decreased. In the right lung, there was extensive stromal fibrosis, leaving almost no normal alveolar structures, and medial hypertrophy of pulmonary arteriolar walls. Hypertrophy of the right heart ventricle due to these pulmonary changes and the congestion of other organs suggested that the cause of death in this case was cor pulmonale due to pulmonary hypertension. This was a rare case of fatal outcome of advanced idiopathic scoliosis without medical care in spite of early detection through mass screening.

  16. Horizontal Gaze Palsy and Progressive Scoliosis With ROBO 3 Mutations in Patients From Cape Verde.

    PubMed

    Mendes Marques, Nadine B P S; Barros, Sandra R; Miranda, Ana F; Nobre Cardoso, João; Parreira, Sónia; Fonseca, Teresa; Donaire, Nelvia M; Campos, Nuno

    2016-10-03

    Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare and autosomal recessive syndrome. We describe 2 cases of HGPPS which are the first documented in patients of African ancestry from an isolated population in Cape Verde. They demonstrated typical findings on neuro-ophthalmic examination and brain magnetic resonance imaging. One patient had novel heterozymous mutations of the ROB0 3 gene.

  17. Incidence and risk factors for post-operative complications after scoliosis surgery in patients with Duchenne muscular dystrophy : a comparison with other neuromuscular conditions.

    PubMed

    Duckworth, A D; Mitchell, M J; Tsirikos, A I

    2014-07-01

    We report the incidence of and risk factors for complications after scoliosis surgery in patients with Duchenne muscular dystrophy (DMD) and compare them with those of other neuromuscular conditions. We identified 110 (64 males, 46 females) consecutive patients with a neuromuscular disorder who underwent correction of the scoliosis at a mean age of 14 years (7 to 19) and had a minimum two-year follow-up. We recorded demographic and peri-operative data, including complications and re-operations. There were 60 patients with cerebral palsy (54.5%) and 26 with DMD (23.6%). The overall complication rate was 22% (24 patients), the most common of which were deep wound infection (9, 8.1%), gastrointestinal complications (5, 4.5%) and hepatotoxicity (4, 3.6%). The complication rate was higher in patients with DMD (10/26, 38.5%) than in those with other neuromuscular conditions (14/84, 16.7% (p = 0.019). All hepatotoxicity occurred in patients with DMD (p = 0.003), who also had an increased rate of deep wound infection (19% vs 5%) (p = 0.033). In the DMD group, no peri-operative factors were significantly associated with the rate of overall complications or deep wound infection. Increased intra-operative blood loss was associated with hepatotoxicity (p = 0.036). In our series, correction of a neuromuscular scoliosis had an acceptable rate of complications: patients with DMD had an increased overall rate compared with those with other neuromuscular conditions. These included deep wound infection and hepatotoxicity. Hepatotoxicity was unique to DMD patients, and we recommend peri-operative vigilance after correction of a scoliosis in this group. ©2014 The British Editorial Society of Bone & Joint Surgery.

  18. Evaluation of postoperative residual spinal deformity and patient outcome in idiopathic scoliosis patients in Japan using the scoliosis research society outcomes instrument.

    PubMed

    Watanabe, Kei; Hasegawa, Kazuhiro; Hirano, Toru; Uchiyama, Seiji; Endo, Naoto

    2007-03-01

    This study clarifies the correlation between the components of the Scoliosis Research Society Outcomes Instrument (SRS-24) and the radiographic parameters after surgery in Japanese idiopathic scoliosis patients. To investigate the correlation between the magnitude of back deformity after scoliosis surgery and the components of the SRS-24. Patient outcomes for Japanese scoliosis patients using the SRS-24 have not been fully investigated. Idiopathic scoliosis patients (n = 81) who were treated with surgery and followed up for more than 2 years were evaluated. Radiographic examination included Cobb angle, rotation angle of apical vertebrae, and translation of the C7 vertebra from the center sacral line on the coronal plane. In addition, the score of one new question regarding postoperative scar was investigated and compared with that of the individual SRS-24 domains. A comparison of the SRS-24 and radiographic results revealed a significant inverse correlation between total pain and the postoperative correction of the rotation angle in the thoracic curve (rs = 0.27; P < 0.05). General self-image was inversely correlated with the Cobb angle (rs = -0.23; P < 0.05) and the rotation angle (rs = -0.30; P < 0.01) in the thoracic curve. Self-image after surgery was positively correlated with the correction degree of the thoracic Cobb angle (rs = 0.27; P < 0.05); 60% of patients had some concerns regarding postoperative scar, and the concerned patients demonstrated significantly lower scores in the pain and general self-image domains (P < 0.05) than the unconcerned patients did. Patients with a greater Cobb angle or rotation angle in the thoracic curve had a negative self-image. Self-image improved after surgery by greater correction of the thoracic Cobb angle. Thoracic scoliotic deformity with prominence should be substantially reduced by the surgical treatment to improve satisfaction rates and self-image regarding back appearance. Additionally, physicians should pay more

  19. Is there a body of evidence for the treatment of patients with Adolescent Idiopathic Scoliosis (AIS)?

    PubMed Central

    Weiss, Hans-Rudolf

    2007-01-01

    Historically, the treatment options for AIS, the most common form of scoliosis are; exercises; in-patient rehabilitation; braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no prospective controlled study comparing the natural history with surgical treatment. One aim of the Scoliosis Society (SOSORT) should be; to help develop a body of research regarding the outcomes of conservative and operative treatment as well, and to highlight the problems of treatment indications in patients with AIS and other spinal deformities. Another aim is to help to improve the safety of patients who have surgery. By producing evidence-based information that can be used to develop guidelines that could aid both professionals and patients in making decisions about surgical and conservative options. Although 'Scoliosis' is the official journal of the SOSORT and is the main forum for experts in the field of conservative management of patients with spinal deformities, there needs to be more wide spread attempt to develop a fuller body of evidence focussing on spine surgery as well. PMID:18163917

  20. Fiber transformations in multifidus muscle of young patients with idiopathic scoliosis.

    PubMed

    Meier, M P; Klein, M P; Krebs, D; Grob, D; Müntener, M

    1997-10-15

    In this study, the authors investigated the superficial multifidus muscle in patients with idiopathic scoliosis. During spinal fusion, biopsies were taken bilaterally at the apex of the curve, and at the upper and lower end vertebrae. To analyze the muscular reactions in response to bracing in patients with idiopathic scoliosis. The extent to which intervertebral mobility is restricted by an orthosis is still controversial. In addition, the effect of bracing on the erector spinae has not been investigated. Of a total 30 patients, 11 had been treated with a corset for a year or more before surgery. Biopsies were investigated histochemically and the muscle fibers classified as Type I, IIA, IIB, or IIC (transitional fibers). The relative distribution of the fibers was calculated and their diameter was measured. In unbraced patients, a shift in the fiber distribution (from "slow" to "fast") was observed exclusively at the concave side of the apex. This shift was paralleled by an increased percentage of the intermediate Type IIC fiber (indicative of fiber transformation). In patients who always wore a corset, the relative amount of Type IIC fibers was increased, without preference for a specific location. Corset treatment elicits muscle fiber transformation processes at different levels along the scoliosis. This general reaction of the paraspinal muscles provides strong evidence against the existence of muscular disorders that are restricted to the area of the apex and are thus causing the scoliosis. As such, it must be assumed that the muscular changes in the apical region are secondary.

  1. Uterine sarcoma: the Hacettepe hospital experience of 88 consecutive patients.

    PubMed

    Ayhan, A; Tuncer, Z S; Tanir, M; Yüce, K; Ayhan, A

    1997-01-01

    The treatment modalities of 88 consecutive patients with uterine sarcomas were reviewed retrospectively in the hope of offering a more rational therapy especially in early stage disease. Of the patients, 47 had Leiomyosarcoma (LMS) (53.4%), 28 had Malignant Mixed Mesodermal Tumor (MMMT) (31.8%) and 8 had Endometrial Stromal Sarcoma (ESS) (9.0%). The patients with uterine sarcoma constituted 7.8% of all patients with uterine malignancies during the study period (88/1124). The mean age of this series at diagnosis was 49.2 years. This figure was 45.1, 53.2 and 35.3 for LMS, MMMT and ESS, respectively. The surgical procedure employed was total abdominal hysterectomy and bilateral salpingoophorectomy (TAH + BSO) in 53 (58.9%) patients and 35 patients underwent TAH + BSO and pelvic and paraaortic lymphadenectomy. The overall incidence of lymph node metastases was 28.5% (4/14) for MMMT and 5.8% (1/17) for LMS cases, respectively. The overall 3-year survival rate of this series was 29.5% (23/88). This figure was found to be 59.4% (22/37) for stage I disease and 27.2 (3/11) for stage II disease; The stage I patients with and without adjuvant therapy had similar survival rates. This study confirms that due to the existence of a substantial risk of lymph node metastasis, a complete surgical staging is necessary in the management of uterine sarcomas particularly of MMMT type. Another deserving finding is the failure to detect any therapeutic effect of adjuvant therapy in stage I patients.

  2. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results

    PubMed Central

    2011-01-01

    Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated

  3. Geometric Torsion in Adolescent Idiopathic Scoliosis: A Surgical Outcomes Study of Lenke Type 1 Patients.

    PubMed

    Shen, Jesse; Kadoury, Samuel; Labelle, Hubert; Parent, Stefan

    2016-12-15

    Consecutive case series analysis. To evaluate the surgical outcomes of patients with thoracic adolescent idiopathic scoliosis (AIS) in relation to different degrees of geometric torsion. AIS is a three-dimensional (3D) deformity of the spine. A 3D classification of AIS, however, remains elusive because there is no widely accepted 3D parameter in the clinical practice. Recently, a new method of estimating geometric torsion has been proposed and detected two potential new 3D subgroups based on geometric torsion values. This is an analysis of 93 patients with Lenke type-1 deformity from our institution. 3D reconstructions were obtained using biplanar radiographs both pre- and postoperatively. Geometric torsion was computed using a novel technique by approximating local arc lengths at the neutral vertebra in the thoracolumbar segment. An inter- and intragroup statistical analysis was performed to compare clinical indices of patients with different torsion values. A qualitative assessment was also performed on each patient by two senior staff surgeons. Statistically significant differences were observed in clinical indices between high (2.85 mm) and low torsion (0.83 mm) Lenke type 1 subgroups. Preoperatively, the high torsion group showed higher Cobb angle values in the thoracic segment (71.18° vs. 63.74°), as well as higher angulation in the thoracolumbar plane of maximum deformity (67.79° vs. 53.30°). Postoperatively, a statistically significant difference was found in the orientation of the plane of maximum deformity in the thoracolumbar segment between the high and low torsion groups (47.95° vs. 30.03°). Results from the qualitative evaluation of surgical results showed different results between the two staff surgeons. These results suggest a link between preoperative torsion values and surgical outcomes within Lenke type 1 deformities. These results will need to be validated by an independent group, as it is a single-center study. 4.

  4. Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan: part II: relation between spinal deformity and patient outcomes.

    PubMed

    Watanabe, Kei; Hasegawa, Kazuhiro; Hirano, Toru; Uchiyama, Seiji; Endo, Naoto

    2005-05-15

    This study clarifies the relation between the results of the Scoliosis Research Society Outcomes Instrument (SRS-24) and radiographic parameters of back deformity in Japanese idiopathic scoliosis patients. To investigate the relation between magnitude of back deformity and results of the SRS-24 in untreated patients. In idiopathic scoliosis, it is necessary to clarify the relation between patient-perceived outcomes of the deformity and magnitude of back deformity before considering treatment. The relation between the magnitude of spinal deformity and outcomes of untreated patients, however, has not been fully investigated. Patients (n = 166) under 30 years of age with untreated scoliosis were evaluated. Radiologic examination included Cobb angle, rotation angle of apical vertebrae, and translation of C7 vertebra from the central sacral line (C7 translation) on the coronal plane. Patient evaluation using section 1 (15 questions) of the SRS-24 was compared with radiologic findings using Spearman's correlation coefficient by rank (rs). The average pain domain score was 27.0 +/- 2.2 points, general self-image 9.9 +/- 1.7 points, general function 12.7 +/- 1.1 points, and overall level of activity 14.9 +/- 0.6 points. In radiologic deformity, the average Cobb angle and rotation angle of the thoracic curve were 35.8 degrees +/- 12.1 degrees (range, 17 degrees-73 degrees) and 13.9 degrees +/- 8.2 degrees (range, 0 degrees-38 degrees), respectively. The average Cobb and rotation angle of the lumbar curve were 31.4 degrees +/- 9.3 degrees (range, 13 degrees-56 degrees) and 15.4 degrees +/- 9.7 degrees (range, 2 degrees-36 degrees), respectively. The mean C7 translation was 12.4 +/- 9.7 mm (range, 0-48 mm). Comparison between individual domains and radiologic measurements revealed that the total pain (rs = -0.33; P < 0.0001) and general self-image (rs = -0.25; P = 0.0024) domain scores had a significant inverse correlation with thoracic curve Cobb angle. Comparison between

  5. Radiation dose reduction in scoliosis patients: low-dose full-spine radiography with digital flat panel detector and image stitching system.

    PubMed

    Grieser, T; Baldauf, A Q; Ludwig, K

    2011-07-01

    To evaluate the exposure dose reduction with a digital flat panel detector (FPD) and an image stitching system (ISS) in full-spine radiography for scoliosis patients. During a 6-month period, all consecutive scoliosis patients with a clinical indication for full-spine radiography (n = 50) were examined with an FPD and ISS. Automatic exposure control adjusted to speed class 1600 was used together with age-adjusted tube voltage and filtration. Dose area products were recorded for all images (antero-posterior n = 50, lateral n = 18). Images were evaluated by two radiologists for the possibility (possible, impossible) of typical scoliosis measurements (Cobb angle, Stagnara angle, lateral deviation, Risser stage). All measurements assessed as impossible underwent a second evaluation categorizing the reason why a measurement was impossible (underlying pathology, projection, image quality). Patient characteristics influencing exposure were recorded (sex, age, weight, height). Mean dose area products were compared to the literature with consideration of patient group and image quality. The mean dose area product was 16.8 µGy m (2) for antero-posterior images and 26.6 µGy m (2) for lateral images. A comparison to published values showed an exposure dose reduction of 47 % to 93 %. Measurement of the Cobb and Stagnara angle, lateral deviation and Risser stage was possible in 96 % (n = 50), 83 % (n = 18), 100 % (n = 50) and 100 % (n = 50) of cases. The reasons for impossible measurements were independent of image quality (underlying pathologies, projection). When imaging scoliosis patients, an FPD combined with an ISS can substantially reduce the exposure dose. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Sensory reweighting is altered in adolescent patients with scoliosis: Evidence from a neuromechanical model.

    PubMed

    Pialasse, Jean-Philippe; Descarreaux, Martin; Mercier, Pierre; Simoneau, Martin

    2015-10-01

    Idiopathic scoliosis is the most frequent spinal deformity in adolescence. While its aetiology remains unclear, impairments in balance control suggest a dysfunction of the sensorimotor control mechanisms. The objective of this paper is to evaluate the ability of patients with idiopathic scoliosis to reweigh sensory information. Using a neuromechanical model, the relative sensory weighting of vestibular and proprioceptive information was assessed. Sixteen healthy adolescents and respectively 20 and 16 adolescents with mild or severe scoliosis were recruited. Binaural bipolar galvanic vestibular stimulation was delivered to elicit postural movement along the coronal plane. The kinematics of the upper body, using normalized horizontal displacement of the 7th cervical vertebra, was recorded 1s before, 2s during, and 1s following vestibular stimulation. The neuromechanical model included active feedback mechanisms that generated corrective torque from the vestibular and proprioceptive error signals. The model successfully predicted the normalized horizontal displacement of the 7th cervical vertebra. All groups showed similar balance control before vestibular stimulation; however, the amplitude (i.e., peak horizontal displacement) of the body sway during and immediately following vestibular stimulation was approximately 3 times larger in patients compared to control adolescents. The outcome of the model revealed that patients assigned a larger weight to vestibular information compared to controls; vestibular weight was 6.03% for controls, whereas it was 13.09% and 13.26% for the mild and severe scoliosis groups, respectively. These results suggest that despite the amplitude of spine deformation, the sensory reweighting mechanism is altered similarly in adolescent patients with scoliosis. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Clavicle chest cage angle difference (CCAD): a novel predictor of postoperative shoulder imbalance in patients with adolescent idiopathic scoliosis.

    PubMed

    Yagi, Mitsuru; Takemitsu, Masakazu; Machida, Masafumi

    2013-05-20

    Retrospective case series of surgically treated patients with adolescent scoliosis. To establish a new radiographical measurement method to determine the best preoperative predictor of postoperative shoulder balance. Shoulder balance is an important aspect of the overall cosmetic balance in patients with adolescent idiopathic scoliosis. Despite recent reports, it is still difficult to estimate the postoperative shoulder balance accurately. A retrospective review of 89 consecutive patients who had thoracic fusion with a minimum 2-year follow-up (mean, 3.1 yr) was conducted to investigate the radiographical measurements and patient demographics. The shoulder height difference (SHD) was measured as the graded height difference of the soft tissue shadows. SHD more than 2 cm indicated an unbalanced shoulder. The clavicle chest cage angle difference (CCAD) was established and evaluated. The CCAD was graded as grade A: no imbalance (<0°), grade B: mild imbalance (0°-10°), and grade C: significant imbalance (>10°). Of the 89 patients, 22 patients had a moderate or significant SHD at 2 years postoperatively and were categorized as the unbalanced shoulder group (unbalanced SD). A significant difference was observed in preoperative CCAD between the balanced and unbalanced SD groups (P = 0.01). The intraclass correlation coefficient for CCAD was 0.94 among the observers. CCAD was consistent from the preoperative to the final postoperative follow-ups in both groups. The classification of the CCAD preoperatively indicated that 12 of 22 (54.4%) patients who were classified into the postoperative unbalanced SD group showed grade 3 CCAD preoperatively, whereas only 9 of 67 (13.4%) patients who were classified in the postoperative balanced SD group had grade 3 CCAD preoperatively. The developed method to predict postoperative shoulder balance was demonstrated to be easy to perform, reliable, and practical. Additionally, we classified the estimation of postoperative shoulder

  8. Brace treatment in infantile/juvenile patients with progressive scoliosis is worthwhile.

    PubMed

    Weiss, Hans-Rudolf

    2012-01-01

    Little information exists about successful brace treatment of progressive early onset scoliosis. Even less information is available about the early treatment of scoliosis patients with Marfan's syndrome at age < 6 years. Purpose of this case report is to demonstrate the possibility of successful brace treatment in a patient with early onset scoliosis due to Marfan's syndrome. A two year old girl diagnosed with Marfan's syndrome presented with a double major scoliosis of 20°. After a follow-up of 6 months she showed a rapid progression to 46° (November 2008) and was braced immediately. In-brace correction in the first Chêneau brace (RSC TM) was moderate due to the stiffness mainly of the lumbar curve. A new brace was made after significant growth (Gensingen braceTM in October 2009). An in-brace correction to 12° thoracic and 12° lumbar has been achieved. In October 2010 she also has outgrown her second brace to some extent. Due to clinical overcorrection (ATR lumbar -5°) brace wearing time has been reduced to 12 hrs. / day at first. In January 2011 at the age of 4 and a half she presented again with an ATR lumbar of -6° still overcorrected clinically, so we decided to leave off the brace for 3 months time. The deformity returned and we had to make a new brace in April 2011. For brace construction a new x-ray has been made showing the curve meanwhile has been reduced to 24° Cobb, however still with significant wedging of the apical vertebra. (1) Successful brace treatment in infantile / juvenile patients with scoliosis is possible. (2) When treated during periods of rapid growth corrections can be achieved with high correction braces. (3) Before early surgery is performed high quality conservative management seems indicated.

  9. Ultrasonography-guided percutaneous nephrolithotomy for the treatment of urolithiasis in patients with scoliosis.

    PubMed

    Li, Hongyan; Zhang, Zhuo; Li, Hai; Xing, Yuanyuan; Zhang, Gang; Kong, Xiangbo

    2012-01-01

    We examined the surgical outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL) in scoliotic patients with complicating urolithiasis. Two patients with scoliosis were hospitalized for MPNCL due to upper tract urolithiasis. Calyx puncture was performed in the prone position under ultrasonographic guidance. The renal access route was established using a set of 8F to 16F dilators, and a transpyelic ballistic lithotriptor was used to fragment the calculi. The stone burdens in the 2 patients were 410 mm(2) and 500 mm(2). The entire operative time was 40 to 70 minutes, and the mean time of establishing percutaneous access was 20 minutes. The calculi were completely removed by single-session pneumatic lithotripsy. The 2 patients recovered from MPCNL uneventfully, and the follow-up radiologic examinations identified no stone residual or recurrence. MPCNL is a minimally invasive modality that is effective and safe for the treatment of urolithiasis in patients with scoliosis.

  10. Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis. Clinical article.

    PubMed

    Shen, Jianxiong; Liang, Jinqian; Yu, Haiquan; Qiu, Guixing; Xue, Xuhong; Li, Zheng

    2014-10-01

    There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections. The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°-135°) and 66.3° ± 11.6° (range 42°-95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010-1.033, and OR 1.546, 95% CI 1.048-2.278, respectively). The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most

  11. Intraoperative monitoring of somatosensory (SSEPs) and transcranial electric motor-evoked potentials (tce-MEPs) during surgical correction of neuromuscular scoliosis in patients with central or peripheral nervous system diseases.

    PubMed

    Pastorelli, F; Di Silvestre, M; Vommaro, F; Maredi, E; Morigi, A; Bacchin, M R; Bonarelli, S; Plasmati, R; Michelucci, R; Greggi, T

    2015-11-01

    Combined intraoperative monitoring (IOM) of transcranial electric motor-evoked potentials (tce-MEPs) and somatosensory-evoked potentials (SSEPs) is safe and effective for spinal cord monitoring during scoliosis surgery. However, the literature data regarding the reliability of spinal cord monitoring in patients with neuromuscular scoliosis are conflicting and need to be confirmed. We reviewed IOM records of 40 consecutive patients with neuromuscular scoliosis related to central nervous system (CNS) (29 pts) or peripheral nervous system (PNS) (11 patients) diseases, who underwent posterior fusion with instrumentation surgery for spinal deformity. Multimodalitary IOM with SSEPs and tce-MEPs was performed. Spinal cord monitoring using at least one modality was attempted in 38/40 (95 %) patients. No false-negative results were present in either group, but a relatively high incidence of false-positive cases (4/29, 13.8 %) was noted in the CNS group. Two patients in the CNS group and one patient in the PNS group presented transient postoperative motor deficits (true positive), related to surgical manoeuvres in two cases and to malposition in the other one. Multimodalitary IOM is safe and effective to detect impending spinal cord and peripheral nerves dysfunction in neuromuscular scoliosis surgery. However, the interpretation of neurophysiological data may be challenging in such patients, and the rate of false-positive results is high when pre-operatory motor deficits are severe.

  12. Results and complications after spinal fusion for neuromuscular scoliosis in cerebral palsy and static encephalopathy using luque galveston instrumentation: experience in 93 patients.

    PubMed

    Lonstein, John E; Koop, Steven E; Novachek, Tom F; Perra, Joseph H

    2012-04-01

    Retrospective cohort analysis. To evaluate the results of spine fusion for neuromuscular scoliosis in cerebral palsy and static encephalopathy, using Luque-Galveston technique, with emphasis on the early and late complications, especially those increasing the hospital stay or requiring additional surgery. There are numerous studies in the literature on the treatment of neuromuscular scoliosis using Luque-Galveston instrumentation analyzing the results and complications. Most series are small and evaluate some of the complications, with none evaluating all the early and late complications and none assessing the impact of the complication on length of hospitalization or the need for additional surgical intervention. This was a retrospective review of a consecutive series of patients operated on for neuromuscular scoliosis in cerebral palsy and static encephalopathy with Luque-Galveston instrumentation at 1 institution from January 1997 to December 2003. Ninety-three patients were identified. The average age at surgery was 14.3 years, with an average age at follow-up of 18.2 years, and an average follow-up of 3.8 years. The mean preoperative scoliosis was 72° with correction postoperatively to a mean of 33°, maintained at 36° at final follow-up. There were 83 early complications in 54 patients, for a complication rate of 58% of patients for the entire study. There were no perioperative deaths or neurological complications. There was only 1 deep wound infection, for an infection rate of 1.1%. Patients with 1 complication had a longer length of stay, 9 versus 7 days, the difference being statistically significant (Mann-Whitney U test, P < 0.001). Two patients required reoperation during the initial hospitalization (1.1%): 1, one for infection and 1 for proximal hook cutout and proximal junction kyphosis. There were a total of 81 late complications in 44 patients, for a late complication rate of 47% of patients for the entire study. The majority of the complications

  13. Computer-aided optimal design of custom scoliosis braces considering clinical and patient evaluations.

    PubMed

    Visser, Daniel; Xue, Deyi; Ronsky, Janet L; Harder, James; Zernicke, Ronald F

    2012-09-01

    Scoliosis causes an abnormal three dimensional curvature of the spine that is often treated by an orthotic device called brace. The objective of this research was to develop a new approach to automatically identify the optimal design of custom-built brace, based on clinical and patient evaluations. In this approach, torso geometry of the scoliosis patient was achieved using a 3-D imaging system that generated a 3-D torso surface model, which was modified using a custom CAD system to design the 3-D brace surface model. Two design parameters, a translational correction factor and a rotational correction factor, were selected to design the brace geometry from the torso geometry. The 3-D digital brace was evaluated by three clinical evaluation measures (imbalance, rib hump and principal axis angle reduction) and one patient evaluation measure (discomfort). A multi-objective optimization method was employed to identify the optimal design parameters considering both clinical and patient evaluations.

  14. Subjective visual vertical in patients with idiopatic scoliosis.

    PubMed

    Cakrt, Ondřej; Slabý, Kryštof; Viktorinová, Lucie; Kolář, Pavel; Jeřábek, Jaroslav

    2011-01-01

    Idiopathic scoliosis (IS) is characterized by a three-dimensional deviation of the vertebral column and its etiopathogenesis is unknown. Various factors are associated with idiopathic scoliosis, among these a prominent role has been attributed to integration of vestibular information with graviception for perception of space. Subjective visual vertical (SVV) is a sensitive sign of verticality perception. The aim of this study was to determine if SVV in adolescents with IS is different from healthy controls. Examination of SVV was performed using the bucket method. Binocular measurements of SVV were made in 23 adolescents with IS (age 14.5 ± 2.5, mean ± SD) and 23 healthy subjects (age 14.0 ± 2.9). The groups differed significantly on SVV deviation (p < 0.01): healthy controls (-0.04° ± 0.64°), IS group (0.86° ± 1.39°). There was also significant difference in SVV uncertainty (p< 0.001): healthy controls (1.50° ± 0.94°), IS group (2.46 ± 0.82°). We conclude that the perception of visual vertical is altered in IS which may play role in development of IS.

  15. [Anaesthesia for correction of scoliosis in pediatric patient with Friedreich's ataxia].

    PubMed

    Agámez Medina, G L; Pantin, E J; Lorthé, J; Therrien, P J

    2015-01-01

    Friedreich ataxia (FA) is an inherited autosomal recessive disease characterized by a neurological degenerative process of the cerebellum, spinal cord, and peripheral nerves. FA is associated with ataxia, dysarthria, motor and sensory impairment, scoliosis, cardiomyopathy, and diabetes. There is a significant risk of perioperative major complications during the anesthetic management of these patients. We present the case of a fourteen-year-old patient with FA, who had a posterior spinal fusion and instrumentation underwent to total intravenous anesthesia.

  16. Although inconvenient, baclofen pumps do not complicate scoliosis surgery in patients with cerebral palsy.

    PubMed

    Yaszay, Burt; Scannell, Brian P; Bomar, James D; Sponseller, Paul D; Shah, Suken A; Asghar, Jahangir; Samdani, Amer F; Bastrom, Tracey P; Newton, Peter O

    2015-04-15

    Retrospective review of prospectively collected data. To compare patients with operative cerebral palsy with and without an intrathecal baclofen pump (ITB) to determine whether an ITB increases the complexity of scoliosis surgery and/or increases the risk of wound complications. Options for baclofen pump placement include before, during, or after scoliosis surgery. There is some concern that prior placement of an ITB and catheter can further complicate cerebral palsy scoliosis surgery and increase the risk for wound complications. Prospectively collected cases from a multicenter cerebral palsy scoliosis database were reviewed for patients who underwent posterior spinal instrumentation and fusion for a major coronal deformity. These patients were then divided on the basis of whether they had ITB at the time of initial scoliosis surgery. The 2 groups were compared to determine differences in demographics, operative parameters, radiographical outcomes, and rates of wound complications. Of 187 patients identified, 32 had an ITB previously placed (ITB group) and 155 did not (non-ITB group). Both groups were similar in regard to age, sex, Gross Motor Function Classification Scale score, and preoperative Cobb magnitude. When comparing operative parameters, there were no differences in the total operating room time (ITB = 375 ± 127 min, non-ITB = 423 ± 178 min; P = 0.149) or total estimated blood loss (ITB = 2323 ± 1489 mL, non-ITB = 2081 ± 1572 mL; P = 0.424). Postoperatively, the 2 groups had similar correction rates (71% vs. 67%, P = 0.303). As for perioperative wound complications, there were no differences in rates (P = 0.546) between the ITB (16%) and non-ITB group (15%). Although it may be inconvenient for the surgeon, ITBs do not increase the complexity of surgery or the risk for wound complications. When counseling patients and their caregivers on the timing of pump placement, it does not seem to compromise the care of the patient if the baclofen pump is

  17. The impact of patient self assessment of deformity on HRQL in adults with scoliosis

    PubMed Central

    Tones, Megan J; Moss, Nathan D

    2007-01-01

    Background Body image and HRQL are significant issues for patients with scoliosis due to cosmetic deformity, physical and psychological symptoms, and treatment factors. A selective review of scoliosis literature revealed that self report measures of body image and HRQL share unreliable correlations with radiographic measures and clinician recommendations for surgery. However, current body image and HRQL measures do not indicate which aspects of scoliosis deformity are the most distressing for patients. The WRVAS is an instrument designed to evaluate patient self assessment of deformity, and may show some promise in identifying aspects of deformity most troubling to patients. Previous research on adolescents with scoliosis supports the use of the WRVAS as a clinical tool, as the instrument shares strong correlations with radiographic measures and quality of life instruments. There has been limited use of this instrument on adult populations. Methods The WRVAS and the SF-36v2, a HRQL measure, were administered to 71 adults with scoliosis, along with a form to report age and gender. Preliminary validation analyses were performed on the WRVAS (floor and ceiling effects, internal consistency and collinearity, correlations with the SF-36v2, and multiple regression with the WRVAS total score as the predictor, and SF-36v2 scores as outcomes). Results The psychometric properties of the WRVAS were acceptable. Older participants perceived their deformities as more severe than younger participants. More severe deformities were associated with lower scores on the Physical Component Summary Score of the SF-36v2. Total WRVAS score also predicted Physical Component Summary scores. Conclusion The results of the current study indicate that the WRVAS is a reliable tool to use with adult patients, and that patient self assessment of deformity shared a relationship with physical rather than psychological aspects of HRQL. The current and previous studies concur that revision of the

  18. Eigenspine: computing the correlation between measures describing vertebral pose for patients with adolescent idiopathic scoliosis.

    PubMed

    Forsberg, Daniel; Lundström, Claes; Knutsson, Hans

    2014-10-01

    This paper describes the concept of eigenspine, a concept applicable for determining the correlation between pair-wise combinations of measures useful for describing the three-dimensional spinal deformities associated with adolescent idiopathic scoliosis. The proposed data analysis scheme is based upon the use of principal component analysis (PCA) and canonical correlation analysis (CCA). PCA is employed to reduce the dimensionality of the data space, thereby providing a regularization of the measurements, and CCA is employed to determine the linear dependence between pair-wise combinations of different measures. The usefulness of the eigenspine concept is demonstrated by analyzing the position and the rotation of all lumbar and thoracic vertebrae as obtained from 46 patients suffering from adolescent idiopathic scoliosis. The analysis showed that the strongest linear relationship is found between the lateral displacement and the coronal rotation of the vertebrae, and that a somewhat weaker but still strong correlation is found between the coronal rotation and the axial rotation of the vertebrae. These results are well in-line with the general understanding of idiopathic scoliosis. Noteworthy though is that the correlation between the anterior-posterior displacement and the sagittal rotation was not as strong as expected and that the obtained results further indicate the need for including the axial vertebral rotation as a measure when characterizing different types of idiopathic scoliosis. Apart from analyzing pair-wise correlations between different measures, the method is believed to be suitable for finding a maximally descriptive low-dimensional combination of measures describing spinal deformities in idiopathic scoliosis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: a 24-month retrospective analysis

    PubMed Central

    Morningstar, Mark W.

    2011-01-01

    Objectives The purpose of this study was to retrospectively report the results of patients who completed an exercise-based chiropractic program and its potential to alter the natural progression of adult scoliosis at 24 months after the clinic portion of treatment was concluded. Methods A retrospective chart review was conducted at 2 spine clinics in Michigan, USA. Each clinic uses the same chiropractic rehabilitation program to treat patients with adult scoliosis. Multidimensional patient outcomes included radiographic, respiratory, disability, and pain parameters. Outcomes were measured at baseline, at end of active treatment, and at long-term follow-up. Results A total of 28 patients fit the inclusion criteria for the study. The average beginning primary Cobb angle was 44° ± 6°. Patients received the same chiropractic rehabilitation program for approximately 6 months. At the end of active treatment, improvements were recorded in Cobb angle, pain scores, spirometry, and disability rating. All radiographic findings were maintained at 24-month follow-up. Conclusion This report is among the first to demonstrate sustained radiographic, self-rated, and physiologic benefits after treatment ceased. After completion of a multimodal chiropractic rehabilitation treatment, a retrospective cohort of 28 adult scoliosis patients reported improvements in pain, Cobb angle, and disability immediately following the conclusion of treatment and 24 months later. PMID:22014907

  20. Influence of proprioceptive insoles on spinal curvature in patients with slight idiopathic scoliosis.

    PubMed

    Noll, Christine; Steitz, Vanessa; Daentzer, Dorothea

    2017-01-01

    Proprioceptive insoles are known to influence the functions of posture and gait by modulations of the sensory structures at the sole of the foot. Literature has shown that they could improve the position of the upper-body in patients with postural complaints of the musculoskeletal system. The aim of this study was to evaluate the influence of proprioceptive insoles on the spinal curvature in patients with slight idiopathic scoliosis. Eighteen patients were included in this prospective, single-centre, randomized study. All patients needed to have a relevant growth potential and suffered from a slight idiopathic scoliosis. Two groups were used, where group 1 performed physiotherapy twice a week, whereas group 2 was additionally supplied with proprioceptive insoles. Patients underwent three-dimensional rasterstereography for back-shape analysis. Furthermore, a conventional x-ray imaging of the spine was performed at the beginning and 1 year later to document the curvatures. There was no statistical difference in the Cobb angles, and in almost all parameters of the rasterstereography, there was no statistically significant change between and within both groups. According to the results of this study, there was no evidence of any statistical significant effect of proprioceptive insoles on spinal curvature in patients with slight idiopathic scoliosis.

  1. Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan: part I: comparison with nonscoliosis group: preliminary/limited review in a Japanese population.

    PubMed

    Watanabe, Kei; Hasegawa, Kazuhiro; Hirano, Toru; Uchiyama, Seiji; Endo, Naoto

    2005-05-15

    This preliminary study evaluates untreated Japanese patients with idiopathic scoliosis using the Scoliosis Research Society Outcomes Instrument (SRS-24). To determine the baseline patient outcome score using the SRS-24 for untreated Japanese scoliosis patients compared with a nonscoliosis group. The SRS instrument with 24 questions was developed to help evaluate patient-perceived outcomes of idiopathic scoliosis treatment. Evaluation of untreated Japanese idiopathic scoliosis patients using the SRS instrument has not been reported. Japanese idiopathic scoliosis patients (n = 141) (mean age, 13.6 years; range, 10-17 years) with a Cobb angle of more than 20 degrees who were not treated with a brace or surgery, were evaluated in comparison with a nonscoliosis group (healthy junior high school students; n = 72) using the SRS-24. The scoliosis group was categorized as mild deformity group with a major curve Cobb angle of less than 30 degrees, moderate deformity group with 30 degrees to 49 degrees, and severe deformity group with more than 50 degrees. The patients were evaluated using section 1 (15 questions) of the SRS-24, which was divided into four domains: total pain, general self-image, general function, and activity. Reliability, as determined by internal consistency, was validated using Cronbach's alpha for these domain scales. The severe deformity group had the lowest scores compared with the other deformity groups and the nonscoliosis group in pain (P < 0.0001) and self-image (P < 0.05) domains. The scores for questions 3 (P < 0.0001) and 5 (P < 0.0001), evaluation of self-image of back appearance, were significantly lower in the scoliosis group than those in the nonscoliosis group. This tendency was more significant in the patients with greater curve magnitude. Scores for questions 14 and 15, evaluation of general self-image, in the scoliosis group were, however, higher than those in the nonscoliosis group. Internal consistency using Cronbach's alpha was 0

  2. Identification of Elongated Primary Cilia with Impaired Mechanotransduction in Idiopathic Scoliosis Patients

    PubMed Central

    Oliazadeh, Niaz; Gorman, Kristen F.; Eveleigh, Robert; Bourque, Guillaume; Moreau, Alain

    2017-01-01

    The primary cilium is an outward projecting antenna-like organelle with an important role in bone mechanotransduction. The capacity to sense mechanical stimuli can affect important cellular and molecular aspects of bone tissue. Idiopathic scoliosis (IS) is a complex pediatric disease of unknown cause, defined by abnormal spinal curvatures. We demonstrate significant elongation of primary cilia in IS patient bone cells. In response to mechanical stimulation, these IS cells differentially express osteogenic factors, mechanosensitive genes, and signaling genes. Considering that numerous ciliary genes are associated with a scoliosis phenotype, among ciliopathies and knockout animal models, we expected IS patients to have an accumulation of rare variants in ciliary genes. Instead, our SKAT-O analysis of whole exomes showed an enrichment among IS patients for rare variants in genes with a role in cellular mechanotransduction. Our data indicates defective cilia in IS bone cells, which may be linked to heterogeneous gene variants pertaining to cellular mechanotransduction. PMID:28290481

  3. Reliability and validity of the Swedish version of the Scoliosis Research Society-22 (SRS-22r) patient questionnaire for idiopathic scoliosis.

    PubMed

    Danielsson, Aina J; Romberg, Karin

    2013-10-01

    Two quality-of-life questionnaires were completed, once or twice, by patients with idiopathic scoliosis from 3 centers for scoliosis care in Sweden. These patients were under observation, during brace treatment, or after treatment with either a brace or surgery. The aim of the study was to translate and validate the revised version of the Scoliosis Research Society Questionnaire (SRS-22r) for use in Sweden. In modern outcome research, the patient's own view of outcome is of great importance. The SRS-22 Questionnaire has been specially designed to measure quality of life in patients with scoliosis and has been used in a number of recent studies. This questionnaire had not previously been used in Sweden. The SRS-22r was translated into Swedish according to accepted methods for the translation of quality-of-life questionnaires. One hundred and forty one patients answered the questionnaire together with the SF-36. Statistical analyses were performed and revealed a somewhat low internal consistency (Cronbach α) of the Function domain/SRS-22, which was found to originate in question number 18. After retranslation, another 52 patients completed the improved questionnaire. Analyses were repeated, and the results improved. When suitable, all 193 patients were therefore analyzed together. Descriptive statistics, distributions, test-retest, and test for concurrent validity showed satisfactory results. After retranslation, the Cronbach alpha for all domain scores was at least 0.72. Discriminant validity was only shown for self-image and management satisfaction/dissatisfaction. The SRS-22r Questionnaire was found to be appropriate for use in our language. Further testing for discriminant validity will be performed. N/A.

  4. Preliminary results and worst-case analysis of in patient scoliosis rehabilitation.

    PubMed

    Weiss, H R; Lohschmidt, K; el-Obeidi, N; Verres, C

    1997-01-01

    The purpose of this study was to assess the effectiveness of a scoliosis-specific rehabilitation programme as it is carried out in the Katharina Schroth Spinal Deformities Rehabilitation Center. Physiotherapy in the treatment of scoliosis patients is still regarded as ineffective since the study by the American Orthopedic Association in 1941, which showed that general exercises could not influence the natural history of scoliosis. However, specific exercise programmes were not known in the USA at that time. This preliminary study started in 1989 with the following inclusion criteria: (1) diagnosis of idiopathic scoliosis; (2) risser sign < 4; (3) no treatment other than physiotherapy; (4) first control after 1-3 years during repeated in patient treatment; (5) standing AP radiograph taken not more than 6 months before the first in patient treatment. A total of 181 scoliosis patients, with an average age of 12.7 years and an average angle of curvature of 27% according to Cobb, were included in this study. The average risser sign was 1.4, the average follow-up 33 months. The Cobb angle of the major curve was measured in a standardized way. The results of our preliminary study were compared to natural history as known from literature. For the worst-case analysis additionally a questionnaire was sent to the non-repeaters treated at our centre at the same time (1989 and 1990) as the patient sample described above, taking into account the same inclusion criteria for this patient sample except point 4. Results showed that progression as usually defined (increase in curvature of 5 degrees or more per year) has not been found in the preliminary study. The patient sample of this study was divided into different age groups and different groups of curve magnitude, for comparison with other studies. Additional to the patient sample of the preliminary study, 116 of the patients from the years 1989 and 1990 fulfilled the inclusion criteria of the preliminary study with the

  5. A correlational study of scoliosis and trunk balance in adult patients with mandibular deviation.

    PubMed

    Zhou, Shuncheng; Yan, Juanjuan; Da, Hu; Yang, Yang; Wang, Na; Wang, Wenyong; Ding, Yin; Sun, Shiyao

    2013-01-01

    Previous studies have confirmed that patients with mandibular deviation often have abnormal morphology of their cervical vertebrae. However, the relationship between mandibular deviation, scoliosis, and trunk balance has not been studied. Currently, mandibular deviation is usually treated as a single pathology, which leads to poor clinical efficiency. We investigated the relationship of spine coronal morphology and trunk balance in adult patients with mandibular deviation, and compared the finding to those in healthy volunteers. 35 adult patients with skeletal mandibular deviation and 10 healthy volunteers underwent anterior X-ray films of the head and posteroanterior X-ray films of the spine. Landmarks and lines were drawn and measured on these films. The axis distance method was used to measure the degree of scoliosis and the balance angle method was used to measure trunk balance. The relationship of mandibular deviation, spine coronal morphology and trunk balance was evaluated with the Pearson correlation method. The spine coronal morphology of patients with mandibular deviation demonstrated an "S" type curve, while a straight line parallel with the gravity line was found in the control group (significant difference, p<0.01). The trunk balance of patients with mandibular deviation was disturbed (imbalance angle >1°), while the control group had a normal trunk balance (imbalance angle <1°). There was a significant difference between the two groups (p<0.01). The degree of scoliosis and shoulder imbalance correlated with the degree of mandibular deviation, and presented a linear trend. The direction of mandibular deviation was the same as that of the lateral bending of thoracolumbar vertebrae, which was opposite to the direction of lateral bending of cervical vertebrae. Our study shows the degree of mandibular deviation has a high correlation with the degree of scoliosis and trunk imbalance, all the three deformities should be clinically evaluated in the

  6. Correlation between pelvic tilt and the sacro-femoral-pubic angle in patients with adolescent idiopathic scoliosis, patients with congenital scoliosis, and healthy individuals.

    PubMed

    Ghandhari, Hassan; Fouladi, Daniel Fadaei; Safari, Mir Bahram; Ameri, Ebrahim

    2016-02-01

    To examine whether the sacro-femoral-pubic (SFP) angle could estimate pelvic tilt (PT) in scoliotic and normal subjects. One hundred nine subjects including 38 patients with adolescent idiopathic scoliosis (AIS), 35 patients with congenital scoliosis (CS), and 36 healthy individuals were studied. PT, as the angle between the lines connecting the midpoint of the sacral plate to the centroid of one acetabulum and the vertical plane, and the SFP angle, as the angle between the midpoint of the upper sacral endplate, the centroid of one acetabulum, and the upper midpoint of the pubic symphysis, were calculated on full-length lateral and anteroposterior radiographs, respectively. Correlations between PT and the SFP angle were investigated in each group. The three groups were comparable in terms of age, sex, and the mean SFP angle. The mean PT, however, was significantly lower in healthy subjects compared to that in patients with AIS and CS. Significant and reverse correlations were present between PT and the SFP angle in all three groups (AIS: r = -0.32, p = 0.04, PT = 82.5 - average SFP angle; CS: r = -0.48, p = 0.003, PT = 95.41 - average SFP angle; healthy: r = -0.33, p = 0.04, PT = 88.95 - average SFP angle). Unlike two previous reports, the SFP angle correlated poorly to PT in this study, limiting its use as a suitable surrogate for PT in scoliotic and healthy subjects.

  7. The Influence of Short-Term Scoliosis-Specific Exercise Rehabilitation on Pulmonary Function in Patients with AIS.

    PubMed

    Moramarco, Marc; Fadzan, Maja; Moramarco, Kathryn; Heller, Amy; Righter, Sonia

    2016-01-01

    To investigate the short-term outcomes of treatment utilizing an outpatient scoliosis- specific back school program in thirty-six patients with adolescent idiopathic scoliosis (AIS). Improved signs and symptoms of AIS have been reported in response to curve-patternspecific exercise therapy programs. Additional outcome studies are needed. Thirty-six patients with adolescent idiopathic scoliosis (AIS), 33 females and 3 males, completed a twenty-hour multimodal exercise program (Schroth Best Practice® - SBP) for five to seven days at Scoliosis 3DC(SM). Average age was 13.89 years and average Cobb angles were 36.92° thoracic and 33.92° lumbar. The sample was comprised of patients under treatment from August 2011 to February 2015 who never had scoliosis-related surgery and who were not undergoing brace treatment. SBP program components included physio-logic® exercises, mobilizations, activities of daily living (ADLs), 3-D Made Easy®, and Schroth exercises. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), chest expansion (CE), and angle of trunk rotation (ATR) were clinical parameters used to evaluate results of this outpatient scoliosis-specific exercise program. Highly significant improvements were noted in FVC, FEV1, CE and Scoliometer(TM) readings. A short-term outpatient SBP program was found to have a positive influence on FVC, FEV1, ATR, and CE. We will present long-term results in a subsequent study.

  8. The Spontaneous Development of Cosmetic Shoulder Balance and Shorter Segment Fusion in Adolescent Idiopathic Scoliosis With Lenke I Curve: A Consecutive Study Followed Up for 2 to 5 Years.

    PubMed

    Tang, Xiangyu; Luo, Xiaobo; Liu, Chao; Fu, Jun; Yao, Ziming; Du, Jianwei; Wang, Yan; Zhang, Yonggang; Zheng, Guoquan

    2016-06-01

    A single-center, retrospective, consecutive case series. To evaluate the spontaneous development of cosmetic shoulder balance (SDCSB) after surgery and to investigate the feasibility of shorter segment fusion in adolescent idiopathic scoliosis (AIS) with Lenke I curve. Upper instrumented vertebrae (UIV) at a more proximal level are always chosen to keep postoperative shoulder balance in AIS. In the guidelines of Rose and Lenke proposed in 2007, for Lenke I right thoracic curves, UIV should be T4 or T5 when the right shoulder is elevated preoperatively, T4 or T3 if the shoulders are level, and T2 when the left shoulder is elevated. Cosmetic shoulder balance (CSB), however, corrects and improves itself postoperatively. Seventy-five consecutive AIS patients with Lenke I curves were followed up for 2 to 5 years postoperatively. Twenty patients (26.7%) selected UIV at the caudal levels in the guidelines of Rose and Lenke (T5 when patients were with right shoulder elevated preoperatively, T4 when patients were with even shoulders preoperatively). Forty-two patients (56.0%) selected UIV at more caudal levels than those suggested by the guidelines. In this study, UIV at the caudal levels in the guidelines and UIV at more caudal levels than those suggested by the guidelines were shorter segment fusion. CSB was measured from photographs. Spinal Appearance Questionnaire (SAQ) was acquired for subjective evaluation of shoulder balance. At last follow-up, the main thoracic curve was 19.5° ± 10.4°, the coronal balance improved to 0.7 ± 0.6 cm, and T2-T12 kyphosis was 34.4° ± 10.8°. At preoperation, immediate postoperation, and last follow-up, the measurements of CSB were 1.1 ± 0.7 cm (range: -2.4 to 1.7 cm), 0.9 ± 0.6 cm (range: -0.8 to 3.1 cm), and 0.6 ± 0.4 cm (range: -0.6 to 1.5 cm). At the three time points, numbers of patients with -1.0 cm < CSB < 1.0 cm were 28 (37.3%), 46 (61.3%), and 70 (93.3%), respectively

  9. Cross-cultural comparison of the Scoliosis Research Society Outcomes Instrument between American and Japanese idiopathic scoliosis patients: are there differences?

    PubMed

    Watanabe, Kei; Lenke, Lawrence G; Bridwell, Keith H; Hasegawa, Kazuhiro; Hirano, Toru; Endo, Naoto; Cheh, Gene; Kim, Yongjung J; Hensley, Marsha; Stobbs, Georgia; Koester, Linda

    2007-11-15

    A comparative study. To report a preliminary evaluation of the Scoliosis Research Society Outcomes Instrument (SRS-24) and determine whether differences in baseline scores exist between American and Japanese patients with idiopathic scoliosis. Because the SRS outcomes instrument was primarily introduced for the American population, baseline scores in the Japanese population might differ from the American population. A comparative study using the SRS instrument between American and Japanese patients with idiopathic scoliosis has not been reported. Two comparable groups of 100 idiopathic scoliosis patients before spinal fusion were separated into American (A) and Japanese (J). There were no statistically significant differences between the groups for gender (A: 9 men/91 women vs. J: 13 men/87 women), age (A: 15.0 +/- 2.4 vs. J: 14.9 +/- 3.8), main curve location (A: 77 thoracic/23 lumbar, J: 76 thoracic/24 lumbar), main curve Cobb angle (A: 50.5 +/- 5.2 vs. J: 51.1 +/- 8.7), and thoracic kyphosis (A: 20.9 +/- 14.3 vs. J: 19.9 +/- 12.1) (P > 0.05, for all comparisons). Patients were evaluated using the first section of the SRS-24 which was divided into 4 domains: total pain, general self-image, general function, and activity. SRS-24 scores were statistical compared in individual domains and questions using the Mann-Whitney U test. American patients had significantly lower scores in pain (P < 0.0001, A: 3.7 +/- 0.8 vs. J: 4.3 +/- 0.4), function (P < 0.01, A: 3.9 +/- 0.6 vs. J: 4.2 +/- 0.5), and activity (P < 0.0001, A: 4.5 +/- 0.8 vs. J: 4.9 +/- 0.3) domains compared with Japanese patients. Japanese patients had significantly lower scores in the self-image (P < 0.0001, A: 4.0 +/- 0.7 vs. J: 3.5 +/- 0.5) domain. With regard to individual questions, there were significant differences in the scores between the 2 groups for all questions except 5 and 13 (P < 0.05, for all comparisons). SRS-24 scores in the Japanese idiopathic scoliosis population differed from that of the

  10. Association between Estrogen Receptor Alpha Gene Polymorphisms and Susceptibility to Idiopathic Scoliosis in Bulgarian Patients: A Case-Control Study

    PubMed Central

    Nikolova, Svetla; Yablanski, Vasil; Vlaev, Evgeni; Stokov, Luben; Savov, Alexey; Kremensky, Ivo

    2015-01-01

    BACKGROUND: The current consensus on idiopathic scoliosis maintains that it has a multifactorial etiology with genetic predisposing factors. AIM: Estrogen receptor alpha gene has been considered as candidate gene of idiopathic scoliosis. MATERIAL AND METHODS: We conducted a case-control study of Bulgarian population samples (eighty patients with idiopathic scoliosis and one hundred-sixty healthy unrelated gender-matched controls) trying to investigate the association between common genetic polymorphisms of estrogen receptor alpha and the susceptibility to idiopathic scoliosis. Molecular detection of the restriction polymorphisms XbaI and PvuII was performed by polymerase chain reaction following by restriction fragment length polymorphism. The statistical analysis was performed by Pearson’s chi-squared test. RESULTS: Our case-control study showed statistically significant association between the PvuII polymorphism and susceptibility to idiopathic scoliosis and curve progression. No genotype or allele of XbaI polymorphism was found to be correlated with the onset or severity of the disease. CONCLUSIONS: The identification of molecular markers with diagnostic and prognostic value could be useful for early detection of children at risk for the development of scoliosis and for prognosis of the risk for a rapid deformity progression. That would facilitate the therapy decisions and early stage treatment of the patient with the least invasive procedures. PMID:27275235

  11. Characterization of radiation exposure in early-onset scoliosis patients treated with the vertical expandable prosthetic titanium rib.

    PubMed

    Cannon, Tyler A; Astur Neto, Nelson; Kelly, Derek M; Warner, William C; Sawyer, Jeffrey R

    2014-03-01

    The evaluation and treatment of patients with early-onset scoliosis requires multiple imaging studies and involves potential exposure to high cumulative lifetime doses of ionizing radiation. The Vertical Expandable Prosthetic Titanium Rib (VEPTR) used in the treatment of early-onset scoliosis requires numerous lengthening procedures and frequent radiographic follow-up. The purpose of this study was to quantify the ionizing radiation exposure in pediatric patients undergoing VEPTR treatment and to identify factors that place patients with early-onset scoliosis at greater risk of radiation exposure. Data were collected by retrospective review of the records of all patients with early-onset scoliosis who were treated with a VEPTR over a 4-year period (2007 to 2010). Diagnostic radiographs, computed tomography, intraoperative fluoroscopy, and nuclear medicine studies were identified and analyzed for ionizing radiation exposure. Total radiation exposure was determined and compared for risk factors such as etiology (eg, neuromuscular or congenital) and surgeon experience. In addition, radiographic studies directly related and unrelated to scoliosis treatment were compared. Twenty-four patients had 121 surgical procedures (mean 5.0/patients) and 962 imaging studies (mean 40/patients). The mean estimated cumulative radiation dose per patient during follow-up was 86.7 mSv (range, 42.6 to 174.9 mSv) with a mean dose per year of 34 mSv (range, 22.9 to 47.1 mSv). Patients with congenital scoliosis received greater mean amounts of radiation (35.2 mSv) than patients with neuromuscular scoliosis (31.9 mSv). Patients treated within the first 2 years of the study period had higher radiation exposure (42.4 mSv) compared with patients treated in the last 2 years (24.9 mSv) (P<0.001). Ionizing radiation is an inevitable side effect of the VEPTR treatment for early-onset scoliosis. There are differences in the amount and sources of radiation exposure between patients with early

  12. Drug Fever Induced by Piperacillin/Tazobactam in a Scoliosis Patient: A Case Report.

    PubMed

    Li, Zheng; Shen, Jianxiong; Li, Qiyi; Chan, Matthew Tak Vai; Wu, William Ka Kei

    2015-11-01

    Drug fever is frequently underrecognized by clinicians despite its common occurrence. Fever induced by piperacillin/tazobactam has not been reported in scoliosis correction surgery.Drug fever caused by piperacillin/tazobactam in a scoliosis patient was described.A 36-year-old woman with adult scoliosis undergoing correction surgery was reported. She developed a fever after an intake of piperacillin/tazobactam for 3 days. Eosinophil count, erythrocyte sedimentation rate, and C-reactive proteins were increased in her blood examination. Thorough history, chest radiography, blood cultures, physical examination, and urinalysis revealed no evidences of fever. A drug fever is therefore considered. The fever lasted for 2 weeks and her body temperature come back to normal 4 days after piperacillin/tazobactam cessation.Fever could be caused by piperacillin/tazobactam. The drug fever's diagnosis is easily confounded by a co-occurring infection. Therefore, it is crucial for clinicians to doubt drugs as a reason when no other origin of fever could be identified in a patient.

  13. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery.

    PubMed

    Sethna, Navil F; Zurakowski, David; Brustowicz, Robert M; Bacsik, Julianne; Sullivan, Lorna J; Shapiro, Frederic

    2005-04-01

    Excessive bleeding often occurs during pediatric scoliosis surgery and is attributed to numerous factors, including accelerated fibrinolysis. The authors hypothesized that administration of tranexamic acid would reduce bleeding and transfusion requirements during scoliosis surgery. Forty-four patients scheduled to undergo elective spinal fusion were randomly assigned to receive either 100 mg/kg tranexamic acid before incision followed by an infusion of 10 mg . kg . h during surgery (tranexamic acid group) or 0.9% saline (placebo group). General anesthesia was administered according to a standard protocol. Blood loss, transfusion requirements, coagulation parameters, and complications were assessed. In the tranexamic acid group, blood loss was reduced by 41% compared with placebo (1,230 +/- 535 vs. 2,085 +/- 1,188 ml; P < 0.01). The amount of blood transfused did not differ between groups (615 +/- 460 vs. 940 +/- 718 ml; P = 0.08). Administration of tranexamic acid was a multivariate predictor of blood loss, as was American Society of Anesthesiologists physical status and preoperative platelet count. No apparent adverse drug effects occurred in any patient. Intraoperative administration of tranexamic acid significantly reduces blood loss during spinal surgery in children with scoliosis.

  14. Health-related quality of life and low back pain of patients surgically treated for scoliosis after 21 years or more of follow-up: comparison among nonidiopathic scoliosis, idiopathic scoliosis, and healthy subjects.

    PubMed

    Akazawa, Tsutomu; Minami, Shohei; Kotani, Toshiaki; Nemoto, Tetsuharu; Koshi, Takana; Takahashi, Kazuhisa

    2012-10-15

    A case-control study. To compare health-related quality of life and low back pain of healthy subjects with those of patients with nonidiopathic scoliosis (non-IS) and idiopathic scoliosis (IS) 21 years or more after surgery. There have been a very small number of reports on long-term results of surgery for non-IS. There have not been any reports that compare non-IS, IS, and healthy subjects. The subjects with scoliosis were 602 patients who had undergone surgery between 1968 and 1988. The Scoliosis Research Society Patient Questionnaire (SRS-22), Roland-Morris Disability Questionnaire (RDQ), and our institution's original questionnaire were used for evaluating long-term clinical outcomes. The 136 respondents consisted of 56 patients with non-IS (non-IS group) and 80 patients with IS (IS group). The control group (CTR group) consisted of 80 healthy volunteers who were age- and body mass index-matched to the scoliosis groups. In the SRS-22, the 3 groups had no significant differences in pain and mental health. For function and self-image, the non-IS group and the IS group had a significantly lower score than the CTR group. In the RDQ, the non-IS group had significantly more severe low back pain than the CTR group. There was no significant difference in low back pain between the non-IS group and IS group or between the IS group and CTR group. The non-IS group had a significantly lower marriage rate than the IS and CTR groups. The patients with non-IS and IS had similar health-related quality of life and low back pain. The patients with non-IS were found to have lower function and self-image in the SRS-22 questionnaire and more severe low back pain in the RDQ than healthy subjects. The patients with non-IS had a significantly lower marriage rate than the other 2 groups.

  15. Implementation of a patient blood management program in pediatric scoliosis surgery.

    PubMed

    Pérez-Ferrer, A; Gredilla-Díaz, E; de Vicente-Sánchez, J; Sánchez Pérez-Grueso, F; Gilsanz-Rodríguez, F

    2016-02-01

    To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution. The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units. The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Diagnostic Accuracy of Combined Multimodality Somatosensory Evoked Potential and Transcranial Motor Evoked Potential Intraoperative Monitoring in Patients With Idiopathic Scoliosis.

    PubMed

    Thirumala, Parthasarathy D; Huang, Jessie; Thiagarajan, Karthy; Cheng, Hannah; Balzer, Jeffrey; Crammond, Donald J

    2016-10-01

    Systematic review. The aim of the study was to determine the predictive value of combined multimodality somatosensory evoked potential (SSEP) and transcranial motor evoked potential (TcMEP) monitoring in detecting impending neurological injury during surgery for idiopathic scoliosis. The diagnostic of motor evoked potential monitoring and SSEP monitoring have been established. However, the predictive value of combined multimodality SSEP and TcMEP monitoring in detecting impending neurological injury during surgery for idiopathic scoliosis has not been evaluated. A systematic literature search was performed using PubMed/MEDLINE, Web of Science, and EMBASE from 1974 to January 2015. All titles and abstracts were independently reviewed by the authors. We included all studies that were (1) randomized controlled trials, prospective or retrospective cohort studies; (2) included patients with idiopathic scoliosis undergoing scoliosis correction surgery; (3) included multimodality SSEP and TcMEP monitoring during spinal surgery; (4) included immediate postoperative neurological assessment; (5) idiopathic scoliosis patient population n ≥25; and (6) published in English. Seven studies comprising a total of 2052 patients with idiopathic scoliosis were included in our meta-analysis. The incidence of neurological deficit in this cohort was 0.93%. The pooled sensitivity, specificity, and Diagnostic Odds Ratio were 82.6% (95% CI 56.7%-94.5%), 94.4% (95% CI 85.1%-98.0%), and 106.16 (95% CI 24.952-451.667), respectively. The area under the curve was 0.928, indicating excellent discriminatory ability. Idiopathic scoliosis corrective surgery patients who experience a new neurological deficit are 106.16 times more likely to have had an SSEP and/or TcMEP change during corrective procedures. The results of this meta-analysis demonstrate that combined multimodality SSEP and TcMEP monitoring possess some advantage over use of each alone, and that intraoperative neurophysiological

  17. Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion.

    PubMed

    Thompson, Mark E; Kohring, Jessica M; McFann, Kim; McNair, Bryan; Hansen, Jennifer K; Miller, Nancy H

    2014-08-01

    Blood loss in patients with adolescent idiopathic scoliosis (AIS) who are undergoing posterior spinal instrumentation and fusion (PSIF) varies greatly. The reason for this wide range is not clear. There are reports of unexpected massive hemorrhage during these surgeries. Many studies reflect authors' preferences for describing blood loss in terms of levels fused, weight, or percent blood volume. We sought to define excessive blood loss clinically, determine its incidence in our study population, and identify associated variables. Results are intended to inform perioperative preparation for these cases. Results may be used to inform prospective study designs. This was a retrospective uncontrolled case series. A total of 311 consecutive AIS PSIF cases during the years 2005-2010 performed at Children's Hospital Colorado were studied. We measured estimated blood loss (EBL) and its association with multiple patient, surgical, and anesthetic variables. Thirty-one variables potentially related to blood loss were collected retrospectively from electronic medical records for analysis. When no cases of clearly excessive blood loss were identified on the basis of visual examination of EBL distribution, we chose to use the top 10% of blood loss cases as an arbitrary determinant of excessive blood loss. Three cut-off strategies captured the top 10% of EBL cases with little variation in who was selected: 1) >1,700 mL of EBL, 2) >50% EBL/estimated blood volume, and 3) >150 mL/level fused EBL. Variables were compared with the χ(2) test, Fisher exact, or t-tests, when appropriate. A generalized linear mixed logistic model was used to determine the probability of excessive blood loss based on the number of levels fused. The average EBL was 89.17 mL/level fused (range, 45-133 mL). EBL fit a progressively wider distribution as surgical complexity (number of levels fused) increased. Number of levels fused (p<.0001), operative time (p=.0139), number of screws (p<.0001), and maximal

  18. Validity of the Spanish version of the Scoliosis Research Society-22 (SRS-22) Patient Questionnaire.

    PubMed

    Climent, Jose M; Bago, Juan; Ey, Anna; Perez-Grueso, Francisco J S; Izquierdo, Enrique

    2005-03-15

    A cross-sectional multicenter study was performed to validate the Spanish version of the Scoliosis Research Society-22 (SRS-22) Patient Questionnaire. To determine the construct validity and convergent validity of the instrument. The Spanish version of the SRS-22 was given to 175 patients with scoliosis (mean age, 19 years old and 86% women). A subgroup of 31 patients also received the Quality of Life for Spine Deformities Profile (QLSDP). Construct validity was studied by factor analysis. Discriminant validity was assessed analyzing the relation between SRS-22 scores and the variables of deformity severity. Convergent validity as related to the QLSDP was studied with a multitrait-multimethod matrix analysis. Factor analysis offered a solution of four factors coherent with the dimensions of the original instrument. SRS-22 scores were worse in older patients (r = -0.34); patients using analgesics demonstrated lower scores (P < 0.001). Patients treated with a brace had a poorer self-image and were less satisfied with their treatment (P < 0.001) than the other treatment groups. Angular improvement of the curves was associated with better self-image scores (r = 0.34). The SRS-22 and QLSDP demonstrated high correlation coefficients in the convergent validity tests (r = 0.84). The Spanish version of the SRS-22 is valid. It has a factorial structure similar to that of the original questionnaire. Moreover, it relates to known severity characteristics of the disease, distinguishes among scoliosis patient groups, and shows concordant values with another valid instrument for measuring self-perceived health.

  19. Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study

    PubMed Central

    2010-01-01

    Background Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis. The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient. Methods/design This prospective, longitudinal cohort study will be incorporated in the usual care of patients with adolescent idiopathic scoliosis. All new patients between 8 and 17 years with adolescent idiopathic scoliosis (Cobb angle >10 degrees) visiting the outpatient clinic of the University Medical Center Groningen are included in this study. Follow up will take place every 6 months. The present study will use a new ultra-low dose X-ray system which can make total body X-rays. Several maturity indicators are evaluated like different body length dimensions, secondary sexual characteristics, skeletal age in hand and wrist, skeletal age in the elbow, the Risser sign, the status of the triradiate cartilage, and EMG ratios of the paraspinal muscle activity. Correlations of all dimensions will be calculated in relationship to the timing of the pubertal growth spurt, and to the progression of the scoliotic curve. An algorithm will be made for the optimal treatment strategy in the individual patient with adolescent idiopathic

  20. The association between Chiari malformation Type I, spinal syrinx, and scoliosis.

    PubMed

    Strahle, Jennifer; Smith, Brandon W; Martinez, Melaine; Bapuraj, J Rajiv; Muraszko, Karin M; Garton, Hugh J L; Maher, Cormac O

    2015-06-01

    OBJECT Chiari malformation Type I (CM-I) is often found in patients with scoliosis. Most previous reports of CM-I and scoliosis have focused on patients with CM-I and a spinal syrinx. The relationship between CM-I and scoliosis in the absence of a syrinx has never been defined clearly. The authors sought to determine if there is an independent association between CM-I and scoliosis when controlling for syrinx status. METHODS The medical records of 14,118 consecutive patients aged ≤ 18 years who underwent brain or cervical spine MRI at a single institution in an 11-year span were reviewed to identify patients with CM-I, scoliosis, and/or syrinx. The relationship between CM-I and scoliosis was analyzed by using multivariate regression analysis and controlling for age, sex, CM-I status, and syrinx status. RESULTS In this cohort, 509 patients had CM-I, 1740 patients had scoliosis, and 243 patients had a spinal syrinx. The presence of CM-I, the presence of syrinx, older age, and female sex were each significantly associated with scoliosis in the univariate analysis. In the multivariate regression analysis, older age (OR 1.02 [95% CI 1.01-1.03]; p < 0.0001), female sex (OR 1.71 [95% CI 1.54-1.90]; p < 0.0001), and syrinx (OR 9.08 [95% CI 6.82-12.10]; p < 0.0001) were each independently associated with scoliosis. CM-I was not independently associated with scoliosis when controlling for these other variables (OR 0.99 [95% CI 0.79-1.29]; p = 0.9). CONCLUSIONS A syrinx was independently associated with scoliosis in a large pediatric population undergoing MRI. CM-I was not independently associated with scoliosis when controlling for age, sex, and syrinx status. Because CM-I is not independently associated with scoliosis, scoliosis should not necessarily be considered a symptom of low cerebellar tonsil position in patients without a syrinx.

  1. A Comparative Study of Sagittal Balance in Patients with Neuromuscular Scoliosis.

    PubMed

    Borges, Paulo Alvim; Zelada, Flávio Gerardo Benites; Dos Santos Barros, Thiago Felipe; Letaif, Olavo Biraghi; da Rocha, Ivan Dias; Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Barros-Filho, Tarcíso Eloy Pessoa

    2017-08-01

    Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification. Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP) from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test. Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters. Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied.

  2. Adult Scoliosis

    MedlinePlus

    Scoliosis Research Society Close Menu Member Login Become a Member Home Find a Specialist | Calendar Contact | Donate ... Conditions & Treatments For Parents For Adolescents For Adults Scoliosis Kyphosis Spondylolysis Other Spine Deformities & Conditions Conditions of ...

  3. Scoliosis (image)

    MedlinePlus

    Abnormal curvature in the spine is known as scoliosis, and generally begins just at the onset of ... growth. Most junior high schools routinely screen for scoliosis because, if caught early, progressive spine curvature can ...

  4. Scoliosis - resources

    MedlinePlus

    Resources - scoliosis ... The following organizations are good resources for information on scoliosis : American Academy of Orthopedic Surgeons -- orthoinfo.aaos.org/topic.cfm?topic=A00626 National Institute of Arthritis and ...

  5. Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy.

    PubMed

    Chang, Hsuan-Kan; Chang, Huang-Chou; Wu, Jau-Ching; Tu, Tsung-Hsi; Fay, Li-Yu; Chang, Peng-Yuan; Wu, Ching-Lan; Huang, Wen-Cheng; Cheng, Henrich

    2016-04-01

    The aim of this paper was to investigate the risk of recurrence of lumbar disc herniation (LDH) in patients with scoliosis who underwent microdiscectomy. A series of consecutive patients who underwent microdiscectomy for LDH was retrospectively reviewed. The inclusion criteria were young adults younger than 40 years who received microdiscectomy for symptomatic 1-level LDH. An exclusion criterion was any previous spinal surgery, including fusion or correction of scoliosis. The patients were divided into 2 groups: those with scoliosis and those without scoliosis. The demographic data in the 2 groups were similar. All medical records and clinical and radiological evaluations were reviewed. A total of 58 patients who underwent 1-level microdiscectomy for LDH were analyzed. During the mean follow-up of 24.6 months, 6 patients (10.3%) experienced a recurrence of LDH with variable symptoms. The recurrence rate was significantly higher among the scoliosis group than the nonscoliosis group (33.3% vs. 2.3%, p = 0.001). Furthermore, the recurrence-free interval in the scoliosis group was short. Young adults (< 40 years) with uncorrected scoliosis are at higher risk of recurrent LDH after microdiscectomy.

  6. Electromyographic responses of erector spinae and lower limb's muscles to dynamic postural perturbations in patients with adolescent idiopathic scoliosis.

    PubMed

    Farahpour, Nader; Ghasemi, Safoura; Allard, Paul; Saba, Mohammad Sadegh

    2014-10-01

    The aim of this study was to evaluate electromyographic (EMG) responses of erector spinae (ES) and lower limbs' muscles to dynamic forward postural perturbation (FPP) and backward postural perturbation (BPP) in patients with adolescent idiopathic scoliosis (AIS) and in a healthy control group. Ten right thoracic AIS patients (Cobb=21.6±4.4°) and 10 control adolescents were studied. Using bipolar surface electrodes, EMG activities of ES muscle at T10 (EST10) and L3 (ESL3) levels, biceps femoris (BF), gastrocnemius lateralis (G) and rectus femoris (RF) muscles in the right and the left sides during FPP and BPP were evaluated. Muscle responses were measured over a 1s time window after the onset of perturbation. In FPP test, the EMG responses of right EST10, ESL3 and BF muscles in the scoliosis group were respectively about 1.40 (p=0.035), 1.43 (p=0.07) and 1.45 (p=0.01) times greater than those in control group. Also, in BPP test, at right ESL3 muscle of the scoliosis group the EMG activity was 1.64 times higher than that in the control group (p=0.01). The scoliosis group during FPP displayed asymmetrical muscle responses in EST10 and BF muscles. This asymmetrical muscle activity in response to FPP is hypothesized to be a possible compensatory strategy rather than an inherent characteristic of scoliosis.

  7. Uveitis in Patients with Retinitis Pigmentosa: 30 Years' Consecutive Data.

    PubMed

    Dutta Majumder, Parthopratim; Menia, Nitin; Roy, Rupak; Sen, Parveen; George, Amala E; Ganesh, Sudha K; Biswas, Jyotirmay

    2017-09-29

    To describe the clinical pattern of uveitis in patients with retinitis pigmentosa (RP) at a tertiary care eye hospital over a period of 30 years. The medical records of 32 eyes of 22 patients of RP with uveitis were included in this study. Collected data included age, subsets of uveitis, best corrected visual acuities (BCVA), detailed laboratory investigations, and treatment. Mean age at presentation was 53.4 ± 18.8 years, and mean age of diagnosis of RP was 39.2 ± 21.4 years. Uveitis was bilateral in 10 (45.5%) patients. The most common of uveitis in current study was anterior uveitis (56.2%), followed by intermediate uveitis (43.8%). Cataract developed in 12 (37.5%) eyes, and three eyes had raised intraocular pressure. Ten patients (45.5%) required oral steroid, and one patient required oral methotrexate. Uveitis in RP patients is rare, but not uncommon. Coexistence of these disorders might support the inflammatory pathway in etiology of RP.

  8. Laparoscopic pyeloplasty: technique and results in 80 consecutive patients.

    PubMed

    Castillo, O A; Cabrera, W; Aleman, E; Vidal-Mora, I; Yañez, R

    2014-03-01

    To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3%. of primary overall success rate. Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  9. Treatment of neuromuscular scoliosis with posterior spinal fusion using the Galveston technique: a retrospective review and results of 62 patients.

    PubMed

    Edwards, Bryan T; Zura, Robert; Bertrand, Styles; Leonard, Sharon; Pellett, Jonathan

    2003-01-01

    Historically, the operative treatment of neuromuscular scoliosis has been associated with a high rate of complication. Recent literature has shown a decreased rate of complication (less 50%) in the management of neuromuscular scoliosis with spinal arthrodesis techniques. A retrospective chart and radiographic review of 62 spinal fusions for neuromuscular scoliosis was performed. There were 53 posterior spinal fusions and 9 anteroposterior spinal fusions. The Galveston technique was used in all patients. The average age at surgery was 13 years 7 months, with an average follow-up of 23 months (minimum 10 months). The mean preoperative and postoperative curve magnitudes were 66 degree and 31 degree, respectively. There were 20 minor complications and 5 major complications in 20 patients. There were no neurologic complications or deaths.

  10. The correlation between calcaneal valgus angle and asymmetrical thoracic-lumbar rotation angles in patients with adolescent scoliosis

    PubMed Central

    Park, Jaeyong; Lee, Sang Gil; Bae, Jongjin; Lee, Jung Chul

    2015-01-01

    [Purpose] This study aimed to provide a predictable evaluation method for the progression of scoliosis in adolescents based on quick and reliable measurements using the naked eye, such as the calcaneal valgus angle of the foot, which can be performed at public facilities such as schools. [Subjects and Methods] Idiopathic scoliosis patients with a Cobb’s angle of 10° or more (96 females, 22 males) were included in this study. To identify relationships between factors, Pearson’s product-moment correlation coefficient was computed. The degree of scoliosis was set as a dependent variable to predict thoracic and lumbar scoliosis using ankle angle and physique factors. Height, weight, and left and right calcaneal valgus angles were set as independent variables; thereafter, multiple regression analysis was performed. This study extracted variables at a significance level (α) of 0.05 by applying a stepwise method, and calculated a regression equation. [Results] Negative correlation (R=−0.266) was shown between lumbar lordosis and asymmetrical lumbar rotation angles. A correlation (R=0.281) was also demonstrated between left calcaneal valgus angles and asymmetrical thoracic rotation angles. [Conclusion] Prediction of scoliosis progress was revealed to be possible through ocular inspection of the calcaneus and Adams forward bending test and the use of a scoliometer. PMID:26834376

  11. The correlation between calcaneal valgus angle and asymmetrical thoracic-lumbar rotation angles in patients with adolescent scoliosis.

    PubMed

    Park, Jaeyong; Lee, Sang Gil; Bae, Jongjin; Lee, Jung Chul

    2015-12-01

    [Purpose] This study aimed to provide a predictable evaluation method for the progression of scoliosis in adolescents based on quick and reliable measurements using the naked eye, such as the calcaneal valgus angle of the foot, which can be performed at public facilities such as schools. [Subjects and Methods] Idiopathic scoliosis patients with a Cobb's angle of 10° or more (96 females, 22 males) were included in this study. To identify relationships between factors, Pearson's product-moment correlation coefficient was computed. The degree of scoliosis was set as a dependent variable to predict thoracic and lumbar scoliosis using ankle angle and physique factors. Height, weight, and left and right calcaneal valgus angles were set as independent variables; thereafter, multiple regression analysis was performed. This study extracted variables at a significance level (α) of 0.05 by applying a stepwise method, and calculated a regression equation. [Results] Negative correlation (R=-0.266) was shown between lumbar lordosis and asymmetrical lumbar rotation angles. A correlation (R=0.281) was also demonstrated between left calcaneal valgus angles and asymmetrical thoracic rotation angles. [Conclusion] Prediction of scoliosis progress was revealed to be possible through ocular inspection of the calcaneus and Adams forward bending test and the use of a scoliometer.

  12. Minimum 20 Years Long-term Clinical Outcome After Spinal Fusion and Instrumentation for Scoliosis: Comparison of the SRS-22 Patient Questionnaire With That in Nonscoliosis Group.

    PubMed

    Iida, Takahiro; Suzuki, Nobumasa; Kono, Katsuki; Ohyama, Yasumasa; Imura, Jyunya; Ato, Akihisa; Ozeki, Satoru; Nohara, Yutaka

    2015-08-15

    A retrospective minimum 20-year follow-up study using 4 standard self-administered questionnaires, one of which, the SRS-22 was also administered to control groups. To evaluate long-term postoperative pain and other clinical outcomes of scoliosis correction and fusion surgery with Harrington instrumentation using Moe square-ended rods for better preservation of sagittal alignment. Only a few long-term outcome studies have used standardized and validated self-administered tools, and no studies have established SRS-22 control data within their own population. There is no previous minimum 20-year follow-up evaluation after correction surgery preserving thoracic kyphosis and lumbar lordosis. Of 86 consecutive patients who underwent instrumentation surgery for scoliosis by a single surgeon, 61 patients participated using Japanese Orthopaedic Association, Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Scoliosis Research Society (SRS-22) questionnaires and 51 patients were included in this study. Results were analyzed for pain and other clinical outcomes. A total of 771 hospital employees were sent SRS-22 questionnaires. A total of 763 responded, resulting in 2 control groups composed of nonscoliosis and untreated mild scoliosis controls of the same culture and language as the long-term follow-up group. The prevalence of continuous low back pain was about 15%. Average Japanese Orthopaedic Association, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores at follow-up were 25 points, 7.3%, and 1.6, respectively. The average SRS-22 scores were 4.2 (function), 4.3 (pain), 3.7 (self-image), and 3.9 (mental health) for the postoperative follow-up group compared with 4.5 (function), 4.3 (pain), 3.5 (self-image), and 3.5 (mental health) for the nonscoliosis controls. Improved preservation of normal sagittal alignment resulted in a prevalence of low back pain comparable with the age-matched general population. Moreover, SRS-22

  13. Histochemical Analysis of Paraspinal Rotator Muscles From Patients With Adolescent Idiopathic Scoliosis

    PubMed Central

    Wajchenberg, Marcelo; Martins, Delio Eulalio; Luciano, Rafael de Paiva; Puertas, Eduardo Barros; Del Curto, David; Schmidt, Beny; Oliveira, Acary Bulle de Souza; Faloppa, Flavio

    2015-01-01

    Abstract Morphological, biochemical, and histopathological alterations in the paraspinal skeletal muscle of patients with adolescent idiopathic scoliosis (AIS) have been extensively reported. We evaluated rotator muscle fibers from the apex vertebra of AIS patients through histological and immunohistochemical analysis. A population of 21 female AIS patients who underwent corrective surgery between 2010 and 2013 had biopsies taken from the paraspinal muscle in the convex and concave sides of the thoracic curve apical vertebra. Serial sections were stained following routine protocols for hematoxylin and eosin (HE), Sudan red, Gomori trichrome, NADH, ATPase, and cytochrome oxidase. We assessed muscular atrophy and hypertrophy, fatty proliferation, endomysial and perimysial fibrosis, the presence of hyaline fibers, mitochondrial proliferation, muscular necrosis, nuclear centralization, and inflammation. Two independent professionals evaluated the slices. The thoracic curves had an average Cobb angle of 68 degree. Comparative analysis of the concave and convex sides was performed with McNemar test at a significance level of 5%. Results showed significant differences in both endomysial and perimysial fibrosis and fatty involution between the two sides of the apex vertebra. Paraspinal muscles in the concave side of the scoliosis apex had significantly more fibrosis and fatty involution. However, both sides showed signs of myopathy, muscular atrophy due to necrosis, presence of hyaline fibers, and mitochondrial proliferation. PMID:25715269

  14. Effectiveness of Providence nighttime bracing in patients with adolescent idiopathic scoliosis.

    PubMed

    Bohl, Daniel D; Telles, Connor J; Golinvaux, Nicholas S; Basques, Bryce A; DeLuca, Peter A; Grauer, Jonathan N

    2014-12-01

    Interest has increased in adolescent idiopathic scoliosis braces that are worn only part time. One such brace, the Providence brace, is being used with increasing frequency despite limited literature evaluating its ability to alter the natural course of disease. The authors retrospectively identified 34 patients meeting modified Scoliosis Research Society (SRS) inclusion criteria who were treated with the Providence brace. In accordance with SRS criteria, patients were followed for progression more than 5°, progression to more than 45°, and recommendation for or performance of surgical fusion. Seventeen (50%) patients progressed more than 5°, and 9 (26%) progressed to more than 45° and had fusion surgery recommended or performed. Noncompliance was associated with progression to more than 45° (P=.045) and having fusion surgery recommended or performed (P=.045). Males had a higher rate of progression more than 5° than did females (100% vs 41%; P=.015). This is only the second study of the Providence brace to be guided by SRS criteria. The somewhat higher rates of progression more than 5° reported in these 2 studies compared with those reported in earlier studies likely result from this distinction. This study suggests a rate of progression that is similar to or lower than rates reported in natural history studies, possibly supporting the efficacy of the Providence brace. Additional studies using SRS criteria, including high-quality randomized, controlled trials, will be important to further understanding the relative effectiveness of this and other bracing protocols.

  15. Responsiveness and Minimal Important Changes of the Scoliosis Research Society-22 Patient Questionnaire in Subjects With Mild Adolescent and Moderate Adult Idiopathic Scoliosis Undergoing Multidisciplinary Rehabilitation.

    PubMed

    Monticone, Marco; Ambrosini, Emilia; Rocca, Barbara; Foti, Calogero; Ferrante, Simona

    2017-06-01

    Single-center, prospective study. Evaluating the responsiveness and minimal important changes (MICs) for the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) in adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AS). Despite the SRS-22 properties have been investigated in various different languages, there is still a lack of information concerning responsiveness and MIC, limiting the use of SRS-22 for clinical and research purposes. At the beginning and end of multidisciplinary rehabilitation programs, 149 subjects with mild AIS (Cobb angle <25°) and 140 subjects with moderate AS (Cobb angle <35°) completed the SRS-22. Upon completing the programs, subjects also performed the global perceived effect (GPE) scales test, which was divided to produce a dichotomous outcome (improved vs. stable). Responsiveness was calculated for all SRS-22 domains but satisfaction with management by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic [ROC] curves; correlations between change scores of the SRS-22 and GPE). ROC curves were also used to compute the MICs. The effect size ranged from 1.23 to 1.50 in AIS and from 1.02 to 1.37 in AS. The standardized response mean ranged from 0.95 to 1.27 in AIS and from 0.66 to 0.90 in AS. The ROC analyses revealed the following MIC values (area under the curve; sensitivity; specificity): function, 0.70 (0.739;66;70) for AIS and 0.60 (0.842;84;76) for AS; pain, 0.70 (0.731;71;70) for AIS and 0.40 (0.817;81;70) for AS; mental health, 0.50 (0.708;83;58) for AIS and 0.55 (0.750;69;78) for AS; self-perceived image, 0.40 (0.609;79;42) for AIS and 0.60 (0.751;61;82) for AS. Correlations between change scores of the SRS-22 domains and GPE were low to moderate, ranging from -0.347 to -0.667. The SRS-22 was sensitive in detecting clinical changes in subjects with adolescent and adult scoliosis. We recommend taking the MICs provided into account when

  16. Comparison of Surgical Outcome of Adolescent Idiopathic Scoliosis and Young Adult Idiopathic Scoliosis: A Match-Pair Analysis of 160 Patients.

    PubMed

    Zhu, Feng; Bao, Hongda; Yan, Peng; Liu, Shunan; Zhu, Zezhang; Liu, Zhen; Bao, Mike; Qiu, Yong

    2017-02-06

    Retrospective study OBJECTIVE.: To investigate if the surgical outcome of young adults was equivalent to adolescents for surgical correction of thoracic adolescent idiopathic scoliosis (AIS). Despite numerous reports on the satisfactory surgical correction, some AIS patients or families still have the assumption that delay of surgery into young adulthood may be more beneficial. Hence, the strict paired analysis of clinical outcome between AIS and adult idiopathic scoliosis (AdIS) is required, which lacks report in the current literatures. This is a retrospective 1:1 matched cohort. A total of 80 pairs were recruited with the following inclusion criteria: (1) female Lenke Type 1A or 1B idiopathic scoliosis; (2) selective fusion; (3) adolescents aged 10-18 years and young adults aged 19-29 years; (4) one-stage posterior approach; (5) all-pedicle-screws instrumentations; (6) major Cobb angle 45°-80°. AIS patients and AdIS patients were matched for apex, major thoracic curve magnitude (±5°), lumbar curve magnitude (±5°), time of surgery (±6 month) and follow-up (±6 month). The age at the time of surgery in AdIS patients averaged 22.21years, significantly larger than that of AIS patients (22.21 vs. 14.47 years). AdIS patients had significant lower curve flexibility. Accordingly, lower correction rate and larger post-operative main Cobb angle were found in AdIS patients. Regarding quality of life, no significant difference was observed between the two groups during follow-up. The results may provide evidence for spine surgeons to communicate with AIS patients and their families regarding pros and cons of the delay of surgery into young adulthood. AIS patients would gain better radiographic curve correction compared to matched AdIS patients due to more flexibility. When considering potential curve progression, the radiographic outcome of AdIS may be even worse. Whereas delaying to adulthood may reduce the risk of adding-on and have similar HRQOL. 3.

  17. Effect of Compliance Counseling on Brace Use and Success in Patients with Adolescent Idiopathic Scoliosis.

    PubMed

    Karol, Lori A; Virostek, Donald; Felton, Kevin; Wheeler, Lesley

    2016-01-06

    Outcomes of orthotic management of idiopathic scoliosis depend on patient compliance with brace wear. The purpose of this study was to determine if counseling based on objective compliance data increases brace wear and therefore reduces the likelihood of surgery. Two hundred and twenty-two patients with adolescent idiopathic scoliosis were prospectively enrolled in a study to determine if physician counseling based on data obtained from compliance monitors (sensors embedded in the brace) improves brace use and decreases curve progression. Patients were placed into two groups. In the counseled group, patients were aware of the compliance monitor in the brace and were counseled at each visit regarding downloaded brace-usage data. The patients in the noncounseled group were not told the purpose of the monitor in their brace, and the compliance data were not made available to the physician, orthotist, or patient. Ninety-three patients who were counseled with use of the compliance data and seventy-eight patients who were not so counseled completed bracing or underwent surgery; twenty-five patients were lost to follow-up before completing brace treatment, and twelve were still undergoing brace treatment at the time of the study review. The average curve magnitude at the initiation of bracing was 33.2° in the counseled group and 33.9° in the noncounseled group (p = 0.21 [not significant]). Patients in the counseled group wore their orthosis an average of 13.8 hours per day throughout their management, while noncounseled patients wore their brace an average of 10.8 hours per day (p = 0.002). Of the counseled patients who finished brace treatment, 59% did not have curve progression of ≥6°, whereas 25% had progression to ≥50° or to surgery. In the noncounseled group, 46% did not have curve progression of ≥6°, whereas 36% had progression to ≥50° or to surgery. Noncounseled patients who had curve progression to a magnitude requiring surgery wore their brace an

  18. Results of Milwaukee and Boston braces with or without metal marker around pads in patients with idiopathic scoliosis.

    PubMed

    Ganjavian, Mohammad Saleh; Behtash, Hamid; Ameri, Ebrahim; Khakinahad, Mohammad

    2011-01-01

    Bracing is the non-operative treatment of choice for adolescent idiopathic scoliosis (AIS) and careful application of pads on apical segment of curve is very important for correction. Control of pads` appropriate site in brace is not easy by clinical evaluation. Therefore, we decided to compare results of braces which for better control of pads by radiographs, metal marker inserted around pads with those without metal marker. We evaluated 215 consecutive cases (182 female, 33 male) of AIS with 342 major curves from 1993 to 2003. Mean initial age was, 13.2 ± 1.8 years (9-16) and mean duration of follow-up was, 16.1 ± 16.4 months (0-114) that treated by 4 type of brace; 89 with type 1(Milwaukee with metal pads), 87 with type 2 (Milwaukee with simple pads), 17 with type 3 (Boston with metal pads) and 22 with type 4(Boston with simple pads). Cobb angle recorded at 5 stages (initial, best, wean, stop and final follow-up). Mean initial Cobb was 36.2°, at stop stage, 35.2° and reached 38° at final follow-up. Overall, 21.3% improved, 42.2% were the same and 36.5% failed. Failure for braces type 1 to 4 were, 40.5%, 34%, 38% and 24% at final follow-up. A total of 59 patients (27.4%) underwent spinal fusion that for brace type 1 to 4 , was, 33, 21, 2 and 3 patients respectively. From 16 cases with initial Cobb of 50°, at follow-up, 12 were ≥50° or had spinal fusion. Correction of lumbar (P=0.008) and main thoracic curves (P=0.002) was better by Boston than Milwaukee, however, In general difference between 4 types of braces was not significant and metal marker had no significant effect on results. Two important predictors of brace failure were, initial curve magnitude and brace type, but using metal marker around pads had no effect in results. It seems that bracing did not alter the natural history of scoliosis in early Risser stages with large magnitude of initial curves. Insertion of metal marker around pads is easy and cheap way that facilitate control of pad sites

  19. Differential proteome analysis of bone marrow mesenchymal stem cells from adolescent idiopathic scoliosis patients.

    PubMed

    Zhuang, Qianyu; Li, Jing; Wu, Zhihong; Zhang, Jianguo; Sun, Wei; Li, Tao; Yan, Yujuan; Jiang, Ying; Zhao, Robert Chunhua; Qiu, Guixing

    2011-04-22

    Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine. The cause and pathogenesis of scoliosis and the accompanying generalized osteopenia remain unclear despite decades of extensive research. In this study, we utilized two-dimensional fluorescence difference gel electrophoresis (2D-DIGE) coupled with mass spectrometry (MS) to analyze the differential proteome of bone marrow mesenchymal stem cells (BM-MSCs) from AIS patients. In total, 41 significantly altered protein spots were detected, of which 34 spots were identified by MALDI-TOF/TOF analysis and found to represent 25 distinct gene products. Among these proteins, five related to bone growth and development, including pyruvate kinase M2, annexin A2, heat shock 27 kDa protein, γ-actin, and β-actin, were found to be dysregulated and therefore selected for further validation by Western blot analysis. At the protein level, our results supported the previous hypothesis that decreased osteogenic differentiation ability of MSCs is one of the mechanisms leading to osteopenia in AIS. In summary, we analyzed the differential BM-MSCs proteome of AIS patients for the first time, which may help to elucidate the underlying molecular mechanisms of bone loss in AIS and also increase understanding of the etiology and pathogenesis of AIS.

  20. Trends of Posterior Long Segment Fusion with and without Recombinant Human Bone Morphogenetic Protein 2 in Patients with Scoliosis

    PubMed Central

    Ruofeng, Yin; Cohen, Jeremiah R.; Buser, Zorica; Yoon, S. Tim; Meisel, Hans-Joerg; Youssef, Jim A.; Park, Jong-Beom; Wang, Jeffrey C.; Brodke, Darrel S.

    2015-01-01

    Study Design  Retrospective study. Objective  Symptomatic scoliosis can be a source of severe pain and disability. When nonoperative treatments fail, spine fusion is considered as an effective procedure in scoliosis management. The purpose of this study was to evaluate the trends of patients with scoliosis undergoing posterior long segment fusion (PLSF) with and without recombinant human bone morphogenetic protein 2 (rhBMP-2). Methods  Patients within the orthopedic subset of Medicare database undergoing PLSF from 2005 to 2011 were identified using the PearlDiver Patient Records Database. Both diagnosis and procedural International Classification of Diseases, ninth edition and Current Procedural Terminology codes were used. The year of procedure, age, sex, region, and rhBMP-2 use were recorded. Results  In total, 1,265,591 patients with scoliosis were identified with 29,787 PLSF surgeries between 2005 and 2011. The incidence of PLSF procedures increased gradually from 2005 to 2009, decreased in 2010 (p < 0 0.01), and grew again in 2011. Patients over age 84 years had the highest incidence of PLSF. The lowest incidence of the procedures was in the Northeast, 5.96 per 100,000 patients. Sex differences were observed with a male-to-female ratio of 0.40 (p < 0.01). The use of rhBMP-2 for PLSF increased steadily from 2005 to 2009; the numbers dropped dramatically in 2010 and returned by 2011. Conclusions  According to our study, patients with scoliosis demonstrated a 0.6575 average incidence increase of PLSF treatments annually. There were significant differences in incidence of PLSF procedure and patient demographics. Additionally, rhBMP-2 consumption significantly changed when we stratified it by sex, age, and region respectively. PMID:27433425

  1. Quantification of topographic changes in the surface of back of young patients monitored for idiopathic scoliosis: correlation with radiographic variables

    NASA Astrophysics Data System (ADS)

    Pino-Almero, Laura; Mínguez-Rey, María Fe; Sentamans-Segarra, Salvador; Salvador-Palmer, María Rosario; Anda, Rosa María Cibrián-Ortiz de; La O, Javier López-de

    2016-11-01

    Idiopathic scoliosis requires a close follow-up while the patient is skeletally immature to detect early progression. Patients who are monitored by radiographs are exposed to high doses of ionizing radiation. The purpose of this study is to evaluate if an optic noninvasive method of back surface topography based on structured light would be clinically useful in the follow-up of young patients with idiopathic scoliosis. This could reduce the number of radiographs made on these children. Thirty-one patients with idiopathic scoliosis were submitted twice to radiograph and our topographic method at intervals of 6 months to 1 year. Three topographical variables were applied horizontal plane deformity index (DHOPI), posterior trunk symmetry index (POTSI), and columnar profile (PC). A statistically significant correlation was found between variations of Cobb angle with DHOPI (r=0.720, p<0.01) and POTSI (r=0.753, p<0.01) during the monitoring period. Hence, this topographic method could be useful in clinical practice as an objective adjuvant tool in routine follow-up of scoliosis.

  2. Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure.

    PubMed

    Presciutti, Steven M; Karukanda, Teja; Lee, Mark

    2014-09-01

    Adolescent idiopathic scoliosis (AIS) patients treated before the 1990s have a 1% to 2% increased lifetime risk of developing breast and thyroid cancer as a result of ionizing radiation from plain radiographs. Although present plain radiographic techniques have been able to reduce some of the radiation exposure, modern treatment algorithms for scoliosis often include computed tomography (CT) and intraoperative fluoroscopy. The exact magnitude of exposure to ionizing radiation in adolescents during modern scoliosis treatment is therefore unclear. To determine the difference in radiation exposures in patients undergoing various forms of treatment for AIS. Retrospective cohort. Patients aged 9 to 18 years with a diagnosis of AIS, followed and/or treated with nonoperative or operative management for a minimum of 2 years. Number of radiographs and total radiation exposure calculated. The charts and radiographs of patients managed for AIS at a single institution between September 2007 and January 2012 were reviewed. Patients were divided into three groups: operative group, braced group, and observation group. Patient demographics, Cobb angles, and curve types were recorded. The number of radiographs per year that each patient received and the total radiation dose were recorded. The plain radiographic radiation exposure was then combined with the direct exposure recording from ancillary tests, such as fluoroscopy and CT, and a radiation exposure rate was calculated (mrad/y). A single-factor analysis of variance (α=0.01) with a Tukey honest significant difference post hoc analysis was used to test significance between groups. Two hundred sixty-seven patients were evaluated: 86 operative, 80 brace, and 101 observation. All groups had similar demographics and curve type distribution. The mean initial Cobb angle at presentation was significantly different between the groups: operative (57°±11°), brace (24°±7.9°), and observation (18°±9.4°) (p<.01). There was a

  3. Update on the management of idiopathic scoliosis.

    PubMed

    Kim, Han Jo; Blanco, John S; Widmann, Roger F

    2009-02-01

    Idiopathic scoliosis is a lateral curvature of the spine greater than 10 degrees for which there is no known cause. This paper reviews the current literature on the appropriate evaluation and treatment of patients with idiopathic scoliosis. Improved technology and surgical techniques are allowing improved curve correction and improved quality of life for these patients. Specifically, the pedicle screw construct can provide excellent curve correction and stabilization for spinal deformities. Idiopathic scoliosis is a diagnosis of exclusion and the approach to a patient with scoliosis should aim toward ruling out other possible causes. In those patients with scoliosis necessitating treatment, bracing should be the first line of treatment and these patients should be followed up closely to track curve progression. Patients who fail conservative management may undergo spinal fusion with pedicle screw instrumentation. Vigilant monitoring and thorough evaluation of scoliosis patients can steer patients toward appropriate management in a judicious manner preventing the significant medical morbidity and deformity that scoliosis can insidiously inflict.

  4. Correlation between the degree of correction of neuromuscular scoliosis and patient quality of life

    PubMed Central

    Nordon, David Gonçalves; Lugão, Ariel Falbel; Machado, Lucas Castrillon Carmo; Marcon, Raphael Martus; Cristante, Alexandre Fogaça; de Barros Filho, Tarcísio Eloy Pessoa; Letaif, Olavo Biraghi

    2017-01-01

    OBJECTIVE: There are few data on patient satisfaction with surgery for the correction of neuromuscular scoliosis or on the correlation between patient satisfaction and the degree of curve correction achieved by surgery. Our aim was to determine the correlations between both patient satisfaction and perception of quality of life and the degree of curve correction. METHODS: We interviewed 18 patients and administered a questionnaire that collected social and economic data and information about functional ability, comorbidities and satisfaction. Statistical analysis was performed using chi-square tests, Pearson correlation and paired t-tests. RESULTS: The mean correction achieved was 42.8%, i.e., 34.17 degrees. Early and late complication rates were low (11.1% each). Almost all of the patients (94.4%) were satisfied with the surgery, and expectations were met for 61.1% of them. Quality of life and aesthetics were improved in 83.4% and 94.4% of cases, respectively. No correlation was found between satisfaction and degree of correction. CONCLUSION: Our surgical results are similar to those of other studies with respect to the degree of correction and patient satisfaction. The disparity between satisfaction and fulfillment of expectations may be due to unrealistic initial expectations or misunderstanding of the objective of surgery. Our findings corroborate the hypothesis that satisfaction is multifactorial and not restricted to a quantitative goal. The satisfaction of patients who undergo operation for neuromuscular scoliosis does not depend directly on the degree of deformity correction. The relationship between satisfaction and the success of the correction procedure is complex and multifactorial. PMID:28273239

  5. Predictors of curve flexibility in adolescent idiopathic scoliosis: a retrospective study of 100 patients.

    PubMed

    Ameri, Ebrahim; Behtash, Hamid; Mobini, Bahram; Daraie, Ariasb

    2015-01-01

    Curve flexibility in adolescent idiopathic scoliosis (AIS) was one of the major concerns of spinal surgeons since the evolution of surgical correction techniques. In this respect, many tried to identify which criteria denote more rigid curve. In the present study, we aimed toward determining important factors influencing AIS curve flexibility on supine bending films. We assessed radiographs of 100 patients with AIS for direction of curves, number of involved vertebrae, apical vertebral translation and rotation, magnitude of main thoracic curve and T5-T12 kyphosis. Statistical analysis performed via stepwise linear regression model with these variables plus age and sex against flexibility index. According to regression analysis, there was a clear relationship between flexibility indexes (FI) and magnitude of main thoracic curve at all (P<0.001). When we consider flexible curves (FI>50%) against rigid curves, apical vertebral rotation was a major determinant of curve flexibility also (P<0.001). Adolescent idiopathic scoliosis curves with larger Cobb's angle and apical vertebral rotation show less flexibility on supine bending films.

  6. Pitfalls and Challenges of Lung Transplant in a Patient With Kartagener Syndrome and Scoliosis.

    PubMed

    Yazicioglu, Alkin; Alici, Ibrahim Onur; Karaoglanoglu, Nurettin; Yekeler, Erdal

    2016-03-14

    We present a 22-year-old woman with Kartagener syndrome and scoliosis who died 112 days after single lung transplant. The classic thoracic involvement of situs inversus totalis and the asymmetric arrangement of the thoracic vascular structures might be a pitfall for surgeon. Anatomic obstacles have forced the surgeon to perform a single transplant. The period of primary graft dysfunction in a single transplanted lung patient was a challenge; supporting the patient with a high flow and long period of extracorporeal membrane oxygenation might lead to a vanishing bronchus. Immotile cilia, a feature of Kartagener syndrome, were another challenge and patient needed several daily aspiration bronchoscopies. Vanishing bronchus is a gradual process with high mortality rates; commonly, stenosis is at the non anastomotic bronchial tree because of insufficient nourishment of the bronchial cartilages. Several repeat bronchoscopic balloon dilatations accompanied with medical treatment were unsuccessful.

  7. Photographing wheelchair-bound patients with neuromuscular scoliosis in a paediatric hospital.

    PubMed

    Wright, Julie; Tsirikos, Athanasios I

    2005-06-01

    This is an investigation of the photography services offered to children and adolescents with neuromuscular scoliosis at the spinal inpatient and outpatient clinic of Great Ormond Street Hospital. The spine service, in cooperation with the medical photography department, sought to identify what clinicians required in the content of photographs as part of the patients' routine clinical assessment, and also what equipment was available on the market to meet these requirements. Current techniques for obtaining medical photographs of this specific group of severely disabled children were also evaluated, and compared to a proposed method of obtaining photographs using the Mangar chair. The authors sought to develop a safe, reliable, patient-friendly and parent-friendly, and easily reproducible technique, which would provide accurate and consistent photographs, and adequately supplement the clinicians' evaluation of patients' conditions.

  8. Regional pulmonary ventilation and perfusion distribution in patients with untreated idiopathic scoliosis

    PubMed Central

    Bake, B.; Bjure, J.; Kasalichý, J.; Nachemson, A.

    1972-01-01

    Regional lung function using xenon-133 was studied in 45 seated patients aged 11 to 78 years with untreated idiopathic scoliosis and angulation of curvature between 10 and 190°. Perfusion distribution was assessed by intravenous bolus injection of 133Xe and distribution of ventilation to volume ratios by washouts after inhalation and intravenous injection. No consistent differences between the lungs on the convex and concave sides of the curvature were found. The lung bases were found to be more severely affected than the apices, perfusion and ventilation being progressively reduced with increasing deformity. There was evidence of inhomogeneity within regions and it is suggested that in younger patients the ventilation and perfusion within regions are better matched than in older patients. PMID:4647630

  9. Electromyographic activity of erector spinae and external oblique muscles during trunk lateral bending and axial rotation in patients with adolescent idiopathic scoliosis and healthy subjects.

    PubMed

    Farahpour, Nader; Younesian, Hananeh; Bahrpeyma, Farid

    2015-06-01

    The aim of this study was to analyze electrical activity of trunk muscles in adolescent idiopathic scoliosis patients and healthy subjects during trunk lateral bending and rotation movements. Ten patients with right thoracic scoliosis [Cobb angle: 29.1° (10.4°)] and 10 control adolescents were studied. Electrical activities of erector spinae muscle at 6th and 10th thoracic and 3rd lumbar vertebral level, and external oblique muscles were measured bilaterally during the right and left bending from standing and prone positions, and trunk rotation in sitting position. In trunk rotation to the right, the right-side external oblique (antagonist) muscle in scoliosis group was greater than that in control group (p<0.05). In left bending from standing position, in scoliosis group, the antagonistic activity of EST6 muscle was greater than its agonistic activity (p<0.05). Also, in the right bending motion, the agonistic activity of external oblique of scoliosis group was higher than that of control group (p=0.02). During the left bending from prone position, right-side EST6 and right-side ESL3 muscles of scoliosis group were greater than that of control group (p<0.05). In left bending from standing position, in scoliosis group, the greater antagonistic activity of erector spinae muscle at 6th thoracic vertebral level than its agonistic activity, indicates that scoliosis is associated with asymmetrical muscle activity. Lateral bending from standing position is appropriate test to distinguish between scoliosis and control subjects. In scoliosis, the asymmetrical muscle activity is not an inherent characteristic since it was not displayed in all back motions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Association of spinal deformity and pelvic tilt with gait asymmetry in adolescent idiopathic scoliosis patients: Investigation of ground reaction force.

    PubMed

    Park, Yang Sun; Lim, Young Tae; Koh, Kyung; Kim, Jong Moon; Kwon, Hyun Joon; Yang, Ji Seung; Shim, Jae Kun

    2016-07-01

    Adolescent idiopathic scoliosis is a prevalent orthopedic problem in children ages 10 to 16years. Although genetic, physiological and biomechanical factors are considered to contribute to the onset and progression of adolescent idiopathic scoliosis, the underlying mechanisms are not yet clear. The purpose of this study was to investigate the association between spinal deformity and inter-leg ground reaction force asymmetry during walking in adolescent idiopathic scoliosis patients. Fourteen patients (3 males and 11 females) participated in this study. Maximum Cobb's angle, adjusted Cobb's angle, and pelvic tilt were calculated from X-ray images. Asymmetry indices between legs were also calculated from ground reaction force magnitude and time variables from their preferred speed walking. Pearson coefficients of correlation were used to investigate associations of asymmetry indices with angle variables. Asymmetry indices of ground reaction force magnitudes positively correlated with adjusted Cobb's angle and maximum Cobb's angle mainly during the peak of braking phase, average of braking phase, while asymmetry indices of ground reaction force time variables showed no significant correlation with adjusted or maximum Cobb's angle. In contrast, asymmetry indices of ground reaction force time variables positively correlated with pelvic tilt during stance phase. We concluded that the spinal deformity of adolescent idiopathic scoliosis patients estimated using the maximum and adjusted Cobb's angles is generally associated with greater asymmetry of ground reaction force magnitudes in walking, while the pelvic tilt is associated with the greater asymmetry of ground reaction force time variables. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. [Answer to the study by von Hopf et al: recommendations to patients with idiopathic scoliosis concerning sports activities].

    PubMed

    von Deimling, U; Vedder, K

    1992-01-01

    A danger for patients with idiopathic scoliosis results not only from push but also from bendstress. For this reason patients treated with a brace should wear it in sports except swimming. Sports with permanent unilateral torsion are to be avoided. Sports with an extremely lordotic or kyphotic effect may be positive in patients with severe kyphosis or lordosis. The patients should take part in school sport activities.

  12. Association between Sacral Slanting and Adjacent Structures in Patients with Adolescent Idiopathic Scoliosis

    PubMed Central

    Lee, Choon Sung; Joo, Youn-Suk; Park, Jungu; Hwang, Chang Ju; Lee, Dong-Ho

    2017-01-01

    Background Sacral slanting is a frequent unique phenomenon in patients with adolescent idiopathic scoliosis (AIS) and may be important for selecting the distal fusion level. However, the reason of the phenomenon remains unknown. The purpose of this study was to determine the association between sacral slanting and adjacent structures in patients with AIS. Methods A total of 303 AIS patients who underwent both whole spine standing anteroposterior (AP) and whole leg standing AP radiography were included. The degree of sacral slanting, pelvic obliquity, lumbar curve angles (L1-L4), and L4 tilt were assessed on whole spine standing AP radiographs. Whole leg standing AP radiographs were used to assess the degree of leg length discrepancy (LLD). Demographic data and radiological parameters were analyzed descriptively. Pearson correlation analysis and partial correlation analysis of the parameters were performed. A p-value of less than 0.05 was considered statistically significant. Results The proportion of patients with ≥ 5° of sacral slanting among those with < 3° of pelvic obliquity was 8.9% (27/303). Thirty-two patients (10.6%, 32/303) showed more than 10 mm of LLD. Sacral slanting was positively correlated with pelvic obliquity and lumbar curve (r = 0.445 and r = 0.325, respectively). Pelvic obliquity was also correlated with LLD and L4 tilt (r = 0.123 and r = 0.311, respectively). However, partial correlation analysis showed that LLD was not directly correlated with sacral slanting (r = −0.034). Conclusions Sacral slanting can be thought to be a compensatory mechanism for large lumbar curves, which is accompanied by pelvic obliquity. In contrast, a congenitally slanted upper sacrum may contribute to scoliosis in some cases. LLD was not directly correlated with sacral slanting. PMID:28261428

  13. Association of Calcium and Phosphate Balance, Vitamin D, PTH, and Calcitonin in Patients With Adolescent Idiopathic Scoliosis.

    PubMed

    Goździalska, Anna; Jaśkiewicz, Jerzy; Knapik-Czajka, Małgorzata; Drąg, Jagoda; Gawlik, Maciej; Cieśla, Maciej; Kulis, Aleksandra; Zarzycki, Daniel; Lipik, Ewa

    2016-04-01

    A cross-sectional study of 2 groups of patients with scoliosis, and an age-matched control group was conducted. Each of the groups such as patients with adolescent idiopathic scoliosis (AIS) as well as control group were divided additionally into 2 groups: premenarcheal and postmenarcheal girls. The aim of the study was to determine the levels of 25-OH-vitamin D3, calcium and phosphate, parathyroid hormone (PTH), and calcitonin in serum of pre- and postmenarcheal girls with AIS and corresponding groups of scoliosis-free controls. The primary etiology and pathogenesis of AIS remains unknown. It is assumed that vitamin D deficiency and genetic predisposition, for example, polymorphisms of vitamin D receptor, have a great significance. Vitamin D plays a key role in skeletal development and prevents bone atrophy, affects the absorption of calcium, maintains calcium-phosphate homeostasis, and the bone matrix mineralization. Its deficiency can result in a wide variety of skeletal deformities, low bone mass, and then leads to the disappearance of bone. Defects in trabecular bone structure and/or bone mineralization are the main features of scoliosis. Some studies have reported that Vitamin D deficiency is common among patients with AIS. The mechanism of Vitamin D action on scoliosis development is still unclear. Determination of serum 25-OH-D3 levels was performed using high-performance liquid chromatography chromatography; concentrations of calcium and phosphate were measured using colorimetric methods, and concentration of PTH and calcitonin was measured using ELISA system. Reduction in the serum levels of 25-OH-D3 and calcitonin in girls with AIS compared with healthy girls was demonstrated. The phosphate-calcium balance and PTH level seem to be normal in patients with AIS. The calcitonin level in girls with AIS is 2-fold lower than in healthy subjects. It is possible that the deficiency of vitamin D can be involved in AIS. 4.

  14. Effect of growing rod on sagittal and spinopelvic parameters in early-onset scoliosis patients.

    PubMed

    Sariyilmaz, Kerim; Akgul, Turgut; Ozkunt, Okan; Dikici, Fatih; Korkmaz, Murat; Sar, Cuneyt; Domanic, Unsal

    2016-05-01

    Growing rod is a commonly used surgery for early-onset scoliosis (EOS). However, the effect of growing-rod lengthening on the spinopelvic alignment is unclear. In this study, 21 EOS patients treated by growing rod were evaluated retrospectively and thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI) , sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA) were measured. Preoperatively, the mean TK, LL, PI, PT, SS, and SVA were 27.4°, 35.2°, 43.8°, 7.5°, 33.8°, and 47.7 mm respectively. After the last lengthening, TK, LL, PI, PT, SS, and SVA were 28.3°, 28.06°, 41.4°, 7°, 5.2°, and 42.6 mm, respectively. The sagittal plane parameters in our EOS patients were not significantly altered during the lengthening period.

  15. New EOS Imaging Protocol Allows a Substantial Reduction in Radiation Exposure for Scoliosis Patients.

    PubMed

    Newton, Peter O; Khandwala, Yash; Bartley, Carrie E; Reighard, Fredrick G; Bastrom, Tracey P; Yaszay, Burt

    2016-03-01

    Prospective. To evaluate the reliability of three-dimensional (3D) spinal models from Micro Dose EOS x-rays compared to standard, Low Dose EOS x-rays utilized for evaluating patients with adolescent idiopathic scoliosis (AIS). There is a strong suggestion that radiation exposure to scoliosis patients can be further reduced. Sixty AIS patients who received biplanar, posteroanterior, and lateral standard Low Dose spine x-rays in our EOS imaging unit (∼0.33 mGy) as part of routine care also underwent an additional set of new reduced "Micro Dose" EOS x-rays (∼0.05 mGy) using a recently developed protocol. Two measurers created 3D models of the images using sterEOS software (Low Dose x2, Micro Dose x2). From this 3D modeling software, coronal Cobb angles, sagittal (T1-T12, T4-T12, L1-L5, L1-S1), and apical axial rotation measurements were obtained. Intraclass correlations (ICCs) and standard error of measurement (upper bound of 95% confidence interval) for the differences between Low Dose and Micro Dose measurements were compared. Interrater reliability was assessed on standard two-dimensional (2D) radiographic measurements. The ICCs were rated as "substantial" to "almost perfect" for Low Dose 3D, Micro Dose 3D, and 2D measures (range 0.78-0.99). The calculated measurement error was not significantly different between groups except for intrarater error on 3D L1-L5 lordosis (2.9° Micro Dose vs. 2.2°, p = .04), interrater 3D rotation of the lumbar apex (2.6° Micro Dose vs. 1.7°, p = .03), and 2D T12-sacrum lordosis (4.6° Micro Dose vs. 3.4°, p = .04). Although statistically significant differences in average measurement error were observed in lordosis and lumbar apex rotation, these differences are not believed to be clinically significant. The Micro Dose images have slightly less clarity qualitatively, yet the critical 2D and 3D measures of the curvature were reliably measured with error of measurement comparable to standard radiologic techniques. Level I

  16. Scoliosis and chest cage deformity measures predicting impairments in pulmonary function: a cross-sectional study of 492 patients with scoliosis to improve the early identification of patients at risk.

    PubMed

    Dreimann, Marc; Hoffmann, Michael; Kossow, Kai; Hitzl, Wolfgang; Meier, Oliver; Koller, Heiko

    2014-11-15

    This study examines the correlations between pulmonary function tests (PFTs) and radiographical measures of spinal deformities in patients with scoliosis. To define the parameters that enable more accurate predictions of restricted pulmonary function (PF) in patients with scoliosis. The early identification of patients with scoliosis who are at risk of developing severe curve progression and restricted PF is critical to improving patient care. A total of 492 patients with a thoracic/thoracolumbar curve (TC) and preoperative PFTs as well as radiographical analysis of the TC and thoracic kyphosis (TK) were assessed. The forced vital capacity (FVC) was expressed as a percentage of the predicted value (FVC%). According to guidelines for the severity of pulmonary impairments, classifications were used: no impairment (FVC > 80%), mild (65 < FVC ≤ 80%), moderate (50 < FVC ≤ 65), and severe impairment (FVC ≤ 50%). Main radiographical parameters were included and statistical analyses were used to identify radiographical predictors and to develop prediction models. The average age was 17 years, 94% of the patients had adolescent idiopathic scoliosis, 20% had lordoscoliosis (TK <10°). The average FVC% was 75% ± 17%, their average TC was 57° ± 21°, and TK was 26° ± 25°. A total of 38% had no impairment, 37% exhibited mild impairment, 15% had moderate impairments, and 10% were severely impaired. Spinal deformities identified by radiographical analysis (TC, TC-flexibility, apical vertebral rotation, TK, and rib hump) significantly influenced FVC% (P < 0.01). TK logistic regression analysis revealed that 2 factors are predictive for an FVC 50% or less: increased scoliosis with a low TK less than 0° (odds ratio = 7.3) or a high TK more than 60° (odds ratio = 20). A model for predicting FVC values more than 50% was established and shown to achieve a correct classification rate of 94%. Patients with increasing coronal and sagittal plane deformities with a high

  17. Effect of physical therapy scoliosis specific exercises using breathing pattern on adolescent idiopathic scoliosis.

    PubMed

    Yoon, Sungyoung; Rhee, Min-Hyung

    2016-11-01

    [Purpose] This study was performed to confirm physical therapy scoliosis specific exercises on adolescent idiopathic scoliosis patients. [Subject and Methods] A 15-year-old male middle school student with scoliosis. Cobb's angle, angle of rotation of the spine, and breathing pattern were measured before and after 8 weeks training. [Results] After 8 weeks training, Cobb's angle, angle of rotation of the spine, and breathing pattern were improved better. [Conclusion] These results indicate that physical therapy scoliosis specific exercises improves scoliosis curves and could provide an effective intervention and management of scoliosis.

  18. Effect of physical therapy scoliosis specific exercises using breathing pattern on adolescent idiopathic scoliosis

    PubMed Central

    Yoon, Sungyoung; Rhee, Min-Hyung

    2016-01-01

    [Purpose] This study was performed to confirm physical therapy scoliosis specific exercises on adolescent idiopathic scoliosis patients. [Subject and Methods] A 15-year-old male middle school student with scoliosis. Cobb’s angle, angle of rotation of the spine, and breathing pattern were measured before and after 8 weeks training. [Results] After 8 weeks training, Cobb’s angle, angle of rotation of the spine, and breathing pattern were improved better. [Conclusion] These results indicate that physical therapy scoliosis specific exercises improves scoliosis curves and could provide an effective intervention and management of scoliosis. PMID:27942163

  19. Changes in life satisfaction and self-esteem in patients with adolescent idiopathic scoliosis with and without surgical intervention.

    PubMed

    Zhang, Jingtao; He, Dawei; Gao, Juan; Yu, Xiuchun; Sun, Haining; Chen, Ziqiang; Li, Ming

    2011-04-20

    Pre-/poststudy comparing surgical and nonsurgical treatment. To identify whether orthopedic spinal surgery can effectively improve life satisfaction and self-esteem in patients with adolescent idiopathic scoliosis. There have been many studies about the effect of spinal deformity and its various treatments on the mental health of patients with adolescent idiopathic scoliosis. Scoliosis has been reported to have a negative effect on the life quality and mental health of patients. It has also been reported that no matter what the treatment, the existence of scoliosis is a risk factor for depression. However, there has been no report on whether orthopedic spinal surgery affects the life satisfaction and self-esteem of scoliosis patients. Forty-six patients with Cobb angles of more than 30° were recruited from a group of patients that were treated from January 2007 to August 2007. Twenty-one patients with Cobb angles of more than 40° underwent surgical correction while the remaining patients received regular observation (n = 11) or bracing (n = 14). Self-esteem and life satisfaction were assessed before and approximately 1 year after treatment using previously validated scales. There were no between-group differences in age, sex, or major curve location between the surgically and nonsurgically treated groups. The major curve Cobb angle decreased significantly following treatment in the surgically treated (52° ± 10° to 15° ± 8°, P < 0.001), but not the nonsurgically treated group (37° ± 9° to 39° ± 8°, P = 0.4419) using paired t tests. There were no preintervention between-group differences in life satisfaction (8 ± 1 vs. 7 ± 10); however, preintervention self-esteem scores were significantly higher in the nonsurgically treated group (28 ± 4 vs. 25 ± 3, P = 0.008). Postintervention, both life satisfaction (9 ± 1) and self-esteem (31 ± 2) scores improved significantly (P < 0.05) in the surgically treated, but not the nonsurgically treated group (7

  20. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach

    PubMed Central

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D

    2016-01-01

    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge. PMID:27695340

  1. Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis

    PubMed Central

    Anwer, Shahnawaz; Alghadir, Ahmad; Abu Shaphe, Md.; Anwar, Dilshad

    2015-01-01

    Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS). Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobb's angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.” Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration's tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS. PMID:26583083

  2. Consecutive Esotropia in Intermittent Esotropia Patients with Immediate Postoperative Overcorrection More Than 17 Prism Diopters

    PubMed Central

    Kim, Hyoung-Seok; Suh, Young-Woo; Kim, Seung Hyun

    2007-01-01

    Purpose To report the incidence and the factors of consecutive esotropia (ET) in patients with immediate postoperative overcorrection of at least 17 prism diopters (PD) after surgery for intermittent exotropia (X(T)). Methods Four-hundred-five patients under the age of 18 were included in this study. They underwent bilateral lateral rectus recession (LROU-rec) or unilateral recession-resection (R&R) for X(T). On postoperative day one, the patients with at least 17 PD overcorrection were classified as group 1 and those with less than 17 PD as group 2. Age, refractive error, type of surgery, lateral incomitancy, and the incidence of consecutive ET were analyzed for each group. Results Group 1 consisted of 116 patients (28.6%) and group 2 consisted of 289 (71.4%). At the six-month follow-up visit, consecutive ET had developed in 16 patients (13.8%) in group 1, and in five patients (1.7%) in group 2 (p<0.001). The occurrence of consecutive ET was not related to age at the time of surgery (p=0.46 in group 1 ; p=0.54 in group 2), refractive error (p=0.18 in group 1 ; p=0.08 in group 2), or the type of surgery (p=0.69 in group 1 ; p=1.00 in group 2). The incidence in group 1 was 23.8% in patients with lateral incomitancy and 8.1% in patients without lateral incomitancy (p<0.05). In group 2, the incidence was 4.4% in patients with lateral incomitancy and 0.5% in patients without lateral incomitancy (p=0.04). Conclusions Consecutive ET developed in 13.8% of patients with immediate overcorrection of at least 17 PD. Lateral incomitancy was the most important risk factor. PMID:17804921

  3. Abnormalities associated with congenital scoliosis: a retrospective study of 226 Chinese surgical cases.

    PubMed

    Shen, Jianxiong; Wang, Zijia; Liu, Jiaming; Xue, Xuhong; Qiu, Guixing

    2013-05-01

    Retrospective study of a series of 226 consecutive Chinese patients with congenital scoliosis. To identify the incidence of intraspinal abnormalities and other organ defects in surgical patients with congenital scoliosis in Chinese population. Previous studies have revealed high rates of intraspinal anomalies and other organ defects in patients with congenital scoliosis. The incidence of abnormalities in patients with congenital scoliosis in Chinese population has not been reported. A total of 226 patients with congenital scoliosis underwent surgical treatment in Peking Union Medical College Hospital between January 2005 and March 2011 were identified. A definitive diagnosis of congenital scoliosis for all patients was made. Complete data were reviewed, including medical records, plain radiograph, magnetic resonance (MR) image of the whole spine, echocardiography, and renal ultrasound. The incidence of intraspinal abnormalities and other organ defects were analyzed. Intraspinal abnormalities were found in 99 (43%) patients. Diastematomyelia was identified to be the most common intraspinal pathological anomaly, which was different from the previous reports. The incidence of intraspinal anomaly in patients with failures of segmentation and mixed defects were significantly higher than those with failures of formation. Patients with thoracic hemivertebrae were found to have a higher incidence of intraspinal abnormalities than patients with lumbar hemivertebrae. Patients with intraspinal abnormality had a higher incidence of positive clinical findings than those with normal magnetic resonance imaging. However, the difference between the 2 groups was not statistically significant. Other organic defects were found in 91(40%) patients. Cardiac defects were detected in 18%, urogenital anomalies in 12%, and gastrointestinal anomalies in 5% of the patients in this study. Diastematomyelia was found to be the most common intraspinal pathological anomaly and cardiac defects were

  4. Radiographic versus ultrasound evaluation of the Risser Grade in adolescent idiopathic scoliosis: a prospective study of 46 patients.

    PubMed

    Thaler, Martin; Kaufmann, Gerhard; Steingruber, Iris; Mayr, Eckart; Liebensteiner, Michael; Bach, Christian

    2008-09-01

    The determination of skeletal age is essential in the management of patients with scoliosis. One of the most frequently used techniques to determine skeletal maturity is the method described by Risser. However, repeated X-ray exposure in the follow-up examinations of scoliosis patients may increase the risk of cancer. We compared conventional radiological evaluation of the Risser grade with ultrasound evaluation. For scoliosis patients routine application of ultrasound in the follow-up examinations may significantly reduce radiation exposure. 46 adolescent idiopathic scoliosis patients (median age, 14.5 years) were investigated. Sonographic and radiographic assessment of Risser sign was carried out by two independent senior staff skeletal radiologists. Agreement of Risser Grade between the two diagnostic methods was determined by Kappa statistics. Coefficients <0.21, 0.21-0.40, 0.41-0.60, 0.61-0.80, and >0.80 were rated as poor, fair, moderate, good, and very good agreement. For Risser Grades I-III 100% agreement was found between the two methods. Disagreement between radiographic and sonographic evaluation was found in Risser Grades IV and V. In five patients, X-ray evaluation yielded Risser Grade V while ultrasound showed Risser Grade IV. In one patient, radiographic examination resulted in Risser Grade IV while Grade V was detected in ultrasound. Overall, the Kappa value showed very good agreement between the two diagnostic methods. Our findings suggest that ultrasound can be applied as an alternative method to X-ray evaluation in Risser Grade determination. It should be routinely used in clinical practice to reduce the patients exposure to radiation.

  5. Postoperative quality of life in patients with progressive neuromuscular scoliosis and their parents.

    PubMed

    Suk, Kyung Soo; Baek, Jin Hee; Park, Jin-Oh; Kim, Hak-Sun; Lee, Hwan-Mo; Kwon, Ji-Won; Moon, Seong-Hwan; Lee, Byung Ho

    2015-03-01

    The functional level of children with progressive neuromuscular disease is a major factor that affects the quality of life (QOL) of parents. However, only a few publications have reported changes in the QOL of parents after correctional spinal surgery. The purpose was to compare changes in QOL for both patients and parents after spinal correctional surgery for better sitting balance and to analyze correlation among radiographic parameters, functional outcome, and QOL questionnaires. Finally, the QOL of patients and parents was compared with the population norm. This study is a retrospective analysis of prospectively gathered data. From 2008 to 2011, 58 patients who underwent correctional surgery for progressive neuromuscular scoliosis and their parents were enrolled. A Muscular Dystrophy Spine Questionnaire (MDSQ) and short-form questionnaire 36 (SF-36) were used. The gathered functional outcome and QOL data using MDSQ and SF-36 for both enrolled patients and parents were compared preoperatively, postoperatively at 3 months, and at 1-year follow-up. Mean age was 15.0±4.1 years. Forty male and 18 female patients were enrolled. Mean follow-up was 38.4±13.7 months. Cobb angle was 61.5°±23.5° preoperatively, 39.0°±20.1° immediately postoperative, and 40.0°±20.2° at the final follow-up. Cobb angle, pelvic obliquity, and lumbar lordosis were significantly improved after surgery (p<.001). Among sitting-related questions, answers to questions 15 (sitting comfortably), 16 (change weight in wheelchair), 22 (sit all day), 24 (sit at table for meal), 26 (keep balance while sitting in wheelchair), and 27 (look good while sitting in wheelchair) were significantly improved after correctional surgery (p<.001). Regarding the SF-36 scales for patients, bodily pain and social functioning significantly improved postoperatively (p<.001). Muscular Dystrophy Spine Questionnaire results indicated that patients had significantly improved sitting balance-related outcomes, whereas

  6. SU-E-I-15: Comparison of Radiation Dose for Radiography and EOS in Adolescent Scoliosis Patients

    SciTech Connect

    Schueler, B; Walz-Flannigan, A

    2014-06-01

    Purpose: To estimate patient radiation dose for whole spine imaging using EOS, a new biplanar slot-scanning radiographic system and compare with standard scoliosis radiography. Methods: The EOS imaging system (EOS Imaging, Paris, France) consists of two orthogonal x-ray fan beams which simultaneously acquire frontal and lateral projection images of a standing patient. The patient entrance skin air kerma was measured for each projection image using manufacturer-recommended exposure parameters for spine imaging. Organ and effective doses were estimated using a commercially-available Monte Carlo simulation program (PCXMC, STUK, Radiation and Nuclear Safety Authority, Helsinki, Finland) for a 15 year old mathematical phantom model. These results were compared to organ and effective dose estimated for scoliosis radiography using computed radiography (CR) with standard exposure parameters obtained from a survey of pediatric radiographic projections. Results: The entrance skin air kerma for EOS was found to be 0.18 mGy and 0.33 mGy for posterior-anterior (PA) and lateral projections, respectively. This compares to 0.76 mGy and 1.4 mGy for CR, PA and lateral projections. Effective dose for EOS (PA and lateral projections combined) is 0.19 mSv compared to 0.51 mSv for CR. Conclusion: The EOS slot-scanning radiographic system allows for reduced patient radiation dose in scoliosis patients as compared to standard CR radiography.

  7. Effectiveness of audio-biofeedback in postural training for adolescent idiopathic scoliosis patients.

    PubMed

    Wong, M S; Mak, A F; Luk, K D; Evans, J H; Brown, B

    2001-04-01

    The possibility of using learned physiological responses in control of progressive adolescent idiopathic scoliosis (AIS) was investigated. Sixteen (16) AIS patients with progressing or high-risk curves (Cobb's angle between 25 degrees and 35 degrees at start and reducible by lateral bending) were fitted with a device with tone alarm for poor posture. In the first 18 months of application, 3 patients defaulted and 4 showed curve progression > 10 degrees (2 changed to rigid spinal orthoses and 2 underwent surgery). The curves for the other 9 patients were kept under control (within +/- 5 degrees of Cobb's angle) and 5 of them have reached skeletal maturity and terminated the application. The remaining 4 patients were still using the devices until skeletal maturity or curve progression. The curve control rate was 69%. A long-lasting active spinal control could be achieved through the patient's own spinal muscles. Nevertheless, before the postural training device could become a treatment modality, a long-term study for more AIS patients was necessary. This project is ongoing in the Duchess of Kent Children's Hospital, Sandy Bay, Hong Kong.

  8. Measurement Properties of the Scoliosis Research Society Outcomes Questionnaire in Adolescent Patients With Spondylolisthesis.

    PubMed

    Gutman, Gabriel; Joncas, Julie; Mac-Thiong, Jean-Marc; Beauséjour, Marie; Roy-Beaudry, Marjolaine; Labelle, Hubert; Parent, Stefan

    2017-09-01

    Prospective validation of the Scoliosis Research Society Outcomes Questionnaire French-Canadian version (SRS-22fv) in adolescent patients with spondylolisthesis. To determine the measurement properties of the SRS-22fv. The SRS-22 is widely used for the assessment of health-related quality of life in adolescent idiopathic scoliosis (AIS) and other spinal deformities. Spondylolisthesis has an important effect on quality of life. The instrument was previously used in this population, although its measurement properties remained unknown. We aim to determine its reliability, factorial, concurrent validity, and its discriminant capacity in an adolescent spondylolisthesis population. The SRS-22fv was tested in 479 subjects (272 patients with spondylolisthesis, 143 with AIS, and 64 controls) at a single institution. Its reliability was measured using the coefficient of internal consistency, concurrent validity by the short form-12 (SF-12v2 French version) and discriminant validity using multivariate analysis of variance, analysis of covariance, and multivariate linear regression. The SRS-22fv showed a good global internal consistency (spondylolisthesis: Cronbach α = 0.91, AIS: 0.86, and controls: 0.78) in all its domains for spondylolisthesis patients. It showed a factorial structure consistent with the original questionnaire, with 60% of explained variance under four factors. Moderate to high correlation coefficients were found for specifically corresponding domains between SRS-22fv and SF-12v2. Boys had higher scores than do girls, scores worsened with increasing age and body mass index. Analysis of covariance showed statistically significant differences between patients with spondylolisthesis, patients with AIS, and controls when controlling for age, sex, body mass index, pain, function, and self-image scores. In the spondylolisthesis group, scores on all domains and mean total scores were significantly lower in surgical candidates and in patients with high

  9. [Echo-morphometric characteristics of human skin in patients with idiopathic scoliosis].

    PubMed

    Grebeniuk, L A; Kobyzev, A E

    2014-01-01

    The purpose of the work was to explore the informational value and methodological aspects of the echographic evaluation of the skin structural characteristics in patients with idiopathic thoracolumbar scoliosis (IS), grades III-IV. The study included 49 patients with grades III-IV IS aged 7-18 years and 16 healthy people. According to echomorphometric data, the age dependence of the of the skin thickness was detected in thoracic, lumbar, areas and in the lower extremity regions. In patients aged 14-16 years with, the asymmetry of skin thickness was found between the left and right areas of the thoracic area (P < 0.05). Skin of thoracic area in IS patients aged 12-16 years was significantly thinner than in healthy persons of the same age. Statistically significant correlation of an average power between the body mass index (BMI) and the skin thickness of thoracic and lumbar areas was detected in IS patients, while in the group of healthy persons there was a highly significant correlation between the skin thickness of the thoracic area and BMI.

  10. Natural History of Adolescent Idiopathic Scoliosis in Skeletally Mature Patients: A Critical Review.

    PubMed

    Agabegi, Steven S; Kazemi, Namdar; Sturm, Peter F; Mehlman, Charles T

    2015-12-01

    The surgical treatment of adolescent idiopathic scoliosis is dependent on several factors, including curve type and magnitude, degree of curve progression, skeletal maturity, and other considerations, such as pain and cosmesis. The most common indication for surgery is curve progression. Most authors agree that surgical treatment should be considered in skeletally mature patients with curves > 50° because of the risk of progression into adulthood. Furthermore, most authors would agree that curves measuring < 40° to 45° in skeletally mature patients should be observed. When a skeletally mature patient with a curve measuring between 45° to 55° is presenting to an orthopaedic surgeon, it is not uncommon that the patient has no pain, no progression, and no imbalance. The generally accepted belief has been that curves that reach 50° are likely to progress into adulthood, progressing at a rate of 1° per year, based largely on the Iowa studies. However, the level of evidence for this is relatively weak, and the existing literature is equivocal in supporting the practice of performing surgery on these patients. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

  11. An advanced compliance monitor for patients undergoing brace treatment for idiopathic scoliosis.

    PubMed

    Chalmers, Eric; Lou, Edmond; Hill, Doug; Zhao, H Vicky

    2015-02-01

    Adolescent idiopathic scoliosis is a spinal deformity affecting 2-3% of adolescents. Brace treatment, the most common non-surgical treatment, uses a hard plastic orthotic shell to prevent progression of the deformity. Previous studies have found association between treatment outcome and patients' compliance with the prescribed brace-wear regimen. However, the exact relationship between compliance and treatment outcome has yet to be elucidated. Current compliance monitoring techniques may not be providing enough information about patients' brace-wear habits. Building on previous work, we present a new compliance monitor which records both temperature and force applied to the patient's body. The combination of temperature and force readings shows both how often and how tightly the brace is worn. The new monitor is designed for minimal size and power consumption, measuring 5.2 cm × 2.5 cm × 0.8 cm, with a battery life of approximately one year. Seven patients wore the monitor in this pilot study. The temperature-based compliance estimate differed significantly from the force-based estimate in four out of seven cases. This suggests that some patients may wear their braces very loosely, and that existing temperature-only or force-only compliance monitors may not be giving a complete picture of brace-wear habits. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  12. Anterior vertebral body tethering for immature adolescent idiopathic scoliosis: one-year results on the first 32 patients.

    PubMed

    Samdani, Amer F; Ames, Robert J; Kimball, Jeff S; Pahys, Joshua M; Grewal, Harsh; Pelletier, Glenn J; Betz, Randal R

    2015-07-01

    This retrospective chart review evaluates the clinical and radiographic outcomes of anterior vertebral body tethering (VBT) at 1-year follow-up. Anterior VBT offers a fusionless treatment option for skeletally immature patients with adolescent idiopathic scoliosis. It is a growth-modulation technique, which utilizes patients' growth to attain progressive scoliosis correction. Numerous animal models support its promise; however, clinical data remain sparse. Clinical and radiographic data were retrospectively analyzed. We reviewed 32 patients who underwent thoracic VBT with a minimum one-year follow-up. Pertinent clinical and radiographic data were collected. ANOVA, Student's t test and Fisher's exact test were utilized to compare different time points. 32 patients with thoracic idiopathic scoliosis (72 % female) with a minimum one-year follow-up were identified; mean age at surgery was 12 years. All patients were considered skeletally immature pre-operatively; mean Risser score 0.42, mean Sanders score 3.2. Patients underwent tethering of an average of 7.7 levels (range 7-11). Median blood loss was 100 cc. The mean pre-operative thoracic curve magnitude was 42.8° ± 8.0° which corrected to 21.0° ± 8.5° on first erect and 17.9° ± 11.4° at most recent. The pre-operative lumbar curve of 25.2° ± 7.3° demonstrated progressive correction (first erect = 18.0° ± 7.1°, 1 year = 12.6° ± 9.4°, p < 0.00001). Thoracic axial rotation measured 13.4° pre-operatively and 7.4° at the most recent measurement (p < 0.00001). One patient experienced prolonged atelectasis which required a bronchoscopy; otherwise, no major complications were observed. Our early results indicate that anterior VBT is a safe and potentially effective treatment option for skeletally immature patients with idiopathic scoliosis. These patients experienced an improvement of their scoliosis with minimal major complications. However, longer term follow-up of this cohort will reveal the true

  13. Prevalence and management of back pain in adolescent idiopathic scoliosis patients: A retrospective study

    PubMed Central

    Théroux, Jean; Le May, Sylvie; Fortin, Carole; Labelle, Hubert

    2015-01-01

    BACKGROUND: Back pain (BP) has often been associated with adolescent idiopathic scoliosis (AIS), which is a three-dimensional deviation of the vertebral column. In adolescents, chronic pain appears to be a predictor of health care utilization and has a negative impact on physical, psychological and family well-being. In this population, BP tends to be persistent and may be a predictor of BP in adulthood. OBJECTIVE: To document the prevalence and management of BP in AIS patients. METHODS: A retrospective chart review of AIS patients who were referred to Sainte-Justine University Teaching Hospital (Montreal, Quebec) from 2006 to 2011 was conducted. RESULTS: A total of 310 randomly selected charts were reviewed. Nearly one-half of the patients (47.3%) mentioned that they experienced BP, most commonly in the lumbar (19.7%) and thoracic regions (7.7%). The type of BP was documented in only 36% (n=112) of the charts. Pain intensity was specified in only 21% (n=65) of the charts. In approximately 80% (n=248) of the charts, no pain management treatment plan was documented. CONCLUSIONS: The prevalence of BP was moderately high among the present sample of adolescents with AIS. An improved system for documenting BP assessment, type, treatment plan and treatment effectiveness would improve pain management for these patients. PMID:25831076

  14. Effects of Schroth and Pilates exercises on the Cobb angle and weight distribution of patients with scoliosis.

    PubMed

    Kim, Gichul; HwangBo, Pil-Neo

    2016-03-01

    [Purpose] The purpose of this study was to compare the effect of Schroth and Pilates exercises on the Cobb angle and body weight distribution of patients with idiopathic scoliosis. [Subjects] Twenty-four scoliosis patients with a Cobb angle of ≥20° were divided into the Schroth exercise group (SEG, n = 12) and the Pilates exercise group (PEG, n = 12). [Methods] The SEG and PEG performed Schroth and Pilates exercises, respectively, three times a week for 12 weeks. The Cobb angle was measured in the standing position with a radiography apparatus, and weight load was measured with Gait View Pro 1.0. [Results] In the intragroup comparison, both groups showed significant changes in the Cobb angle. For weight distribution, the SEG showed significant differences in the total weight between the concave and convex sides, but the PEG did not show significant differences. Furthermore, in the intragroup comparison, the SEG showed significant differences in the changes in the Cobb angle and weight distribution compared with the PEG. [Conclusion] Both Schroth and Pilates exercises were effective in changing the Cobb angle and weight distribution of scoliosis patients; however, the intergroup comparison showed that the Schroth exercise was more effective than the Pilates exercise.

  15. Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction.

    PubMed

    Takaso, Masashi; Nakazawa, Toshiyuki; Imura, Takayuki; Okada, Takamitsu; Fukushima, Kensuke; Ueno, Masaki; Takahira, Naonobu; Takahashi, Kazuhisa; Yamazaki, Masashi; Ohtori, Seiji; Okamoto, Hirotsugu; Okutomi, Toshiyuki; Okamoto, Makihito; Masaki, Takashi; Uchinuma, Eijyu; Sakagami, Hiroyuki

    2010-06-01

    In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients' and parents' satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high.

  16. Requirements and characteristics of 500 consecutive patients consulting an ophthalmic medical practitioner.

    PubMed Central

    Claoué, C M

    1988-01-01

    This paper reports the results of a prospective survey on 500 consecutive patients consulting an ophthalmic medical practitioner. The reason for consultation, and results of refraction and examination were analysed. The majority required only a refraction. One in 8 visits was for primary ophthalmic health care other than refraction. An abnormality of the visual system (other than refractive error) was present in 19% of patients. Five per cent required referral to their general practitioner. PMID:3411589

  17. Neuromuscular Scoliosis

    MedlinePlus

    ... degree of neuromuscular involvement. Diagnosis Incidence of Scoliosis Cerebral palsy (2 limbs involved) 25% Myelodysplasia (lower lumbar) 60% Spinal muscle atrophy 67% Friedreich ataxia 80% Cerebral palsy (4 limbs involved) 80% Duchenne muscular dystrophy 90% ...

  18. Effects of submental stimulation for several consecutive nights in patients with obstructive sleep apnoea.

    PubMed Central

    Hida, W.; Okabe, S.; Miki, H.; Kikuchi, Y.; Taguchi, O.; Takishima, T.; Shirato, K.

    1994-01-01

    BACKGROUND--It has previously been reported that short term submental stimulation can reduce the frequency of apnoea and improve sleep architecture in patients with obstructive sleep apnoea. The effects of submental stimulation during consecutive nights on apnoea or on daytime sleepiness have not, however, been studied. METHODS--Patients with obstructive sleep apnoea were studied by polysomnography on a control night, for five consecutive nights of submental stimulation, and on three following nights (n = 8). A multiple sleep latency test (MSLT) (n = 8) and measurement of the upper airway resistance (n = 5) were performed during the day after the polysomnographic study, on the control night, and on the fifth stimulation night. In an additional five patients with obstructive sleep apnoea, matched for age, sex, and weight, the effects of two nights of stimulation were examined for comparison. Submental stimulation began when an apnoea lasted for five seconds and stopped with the resumption of breathing as detected by oronasal flow. RESULTS--The apnoea index, the number of times per hour that SaO2 dropped below 85% (SaO2 < 85%/hour), and the total apnoea duration expressed as a percentage of total sleep time during stimulation nights decreased to approximately 50% of the corresponding values on the control night. This improvement persisted for at least two nights after the five consecutive stimulation nights, but not after the two consecutive stimulation nights. Sleep architecture and MSLT following the stimulation nights improved but upper airway resistance did not change. CONCLUSIONS--Submental stimulation for five consecutive nights in patients with obstructive sleep apnoea improved the breathing disturbance, sleep quality, and daytime sleepiness. The effect lasted for the following two nights, but did not completely abolish the sleep disordered breathing. PMID:8016764

  19. [Evaluation of the sagittal profile in patients with thoracic adolescent idiopathic scoliosis Lenke type 1 following posterior correction].

    PubMed

    Akbar, M; Dreher, T; Schwab, F; Omlor, G; Wang, H; Bruckner, T; Carstens, C; Wiedenhöfer, B

    2013-03-01

    The principle philosophy of posterior spinal instrumentation and fusion (PSIF) for the treatment of adolescent idiopathic scoliosis (AIS) has changed during recent decades. In the past the treatment of AIS mainly focused on correction of the major curve in the frontal plane while the sagittal profile and balancing were only of inferior interest in treatment planning. Various long-term outcome studies have demonstrated that many AIS patients developed a flatback syndrome (decrease of thoracic kyphosis and lumbar lordosis) associated with pain. It was concluded that treatment of AIS should consider the sagittal profile and balance; however, there are only few studies addressing additional procedures, which include the correction of the sagittal profile. The purpose of this study was to evaluate the effects of different posterior correction techniques on sagittal profile and balance. A total of 36 consecutive patients with thoracic AIS, who were treated with selective thoracic posterior correction were included in this retrospective study. The patients were further assigned to three different subgroups according to different surgical strategies: A: pedicle screws, B: long-head pedicle screws and C: additional Ponte osteotomy. Standardized radiographs in the standing position of the whole spine in two planes were evaluated before and at least 2 years after correction for all patients and a subgroup analysis was done to identify differences between the three groups. A significant correction of the major curve was achieved in all three groups (p < 0.001). There was a significant difference between the groups with groups B and C showing significantly higher levels of major curve correction in comparison to group A (p < 0.001). Concerning the sagittal profile, there was a significant difference in the development of thoracic kyphosis (TK) and lumbar lordosis (LL). While a significant reduction of TK and LL was found in groups A and B after surgery, a significant increase

  20. Experimental validation of a patient-specific model of orthotic action in adolescent idiopathic scoliosis.

    PubMed

    Vergari, Claudio; Courtois, Isabelle; Ebermeyer, Eric; Bouloussa, Houssam; Vialle, Raphaël; Skalli, Wafa

    2016-10-01

    Personalized modeling of brace action has potential in improving brace efficacy in adolescent idiopathic scoliosis (AIS). Model validation and simulation uncertainty are rarely addressed, limiting the clinical implementation of personalized models. We hypothesized that a thorough validation of a personalized finite element model (FEM) of brace action would highlight potential means of improving the model. Forty-two AIS patients were included retrospectively and prospectively. Personalized FEMs of pelvis, spine and ribcage were built from stereoradiographies. Brace action was simulated through soft cylindrical pads acting on the ribcage and through displacements applied to key vertebrae. Simulation root mean squared errors (RMSEs) were calculated by comparison with the actual brace action (quantified through clinical indices, vertebral positions and orientations) observed in in-brace stereoradiographies. Simulation RMSEs of Cobb angle and vertebral apical axial rotation was lower than measurement uncertainty in 79 % of the patients. Pooling all patients and clinical indices, 87 % of the indices had lower RMSEs than the measurement uncertainty. In-depth analysis suggests that personalization of spinal functional units mechanical properties could improve the simulation's accuracy, but the model gave good results, thus justifying further research on its clinical application.

  1. Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

    PubMed Central

    Nakazawa, Toshiyuki; Imura, Takayuki; Okada, Takamitsu; Fukushima, Kensuke; Ueno, Masaki; Takahira, Naonobu; Takahashi, Kazuhisa; Yamazaki, Masashi; Ohtori, Seiji; Okamoto, Hirotsugu; Okutomi, Toshiyuki; Okamoto, Makihito; Masaki, Takashi; Uchinuma, Eijyu; Sakagami, Hiroyuki

    2010-01-01

    In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients’ and parents’ satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high. PMID:20155495

  2. The influence of vision and support base on balance during quiet standing in patients with adolescent idiopathic scoliosis before and after posterior spinal fusion.

    PubMed

    de Santiago, Hildemberg A R; Reis, Júlia G; Gomes, Matheus M; da Silva Herrero, Carlos F P; Defino, Helton L A; de Abreu, Daniela C C

    2013-11-01

    Scoliosis is the most common postural alteration in adolescence and is characterized by deviations of the spine in three planes. Surgical treatment based on arthrodesis has been developed, but the effects of such restructuring on the systems involved in postural control need to be better understood. To assess the influence of vision and the support base on balance in the quiet standing position in adolescents awaiting surgical treatment for idiopathic scoliosis. Longitudinal study/Ribeirão Preto Clinics Hospital (HC-FMRP-USP) and Laboratory of Assessment and Rehabilitation of Equilibrium at the FMRP-USP. Adolescent idiopathic scoliosis patients and controls. Center of pressure (CoP) sway area of the 95% confidence ellipse. Thirty female adolescents were divided into two groups according to their spinal alignment: control (n=15) and scoliosis groups (SGs) (n=15). The subjects with scoliosis were evaluated before and 7, 30, 60, and 90 days after surgery; the controls were evaluated once. The area of CoP oscillation was measured with the eyes open and closed and with two different support bases (feet apart or together). The force platform was purchased with funding support (US $8,375.00) provided by the Research Foundation of São Paulo (FAPESP). The study sponsors had no involvement in the study. Data were collected from the force platform and then statistically assessed through a linear model analysis of mixed effects. Data reveal that subjects in the SG oscillated more than controls, and postsurgery subjects had more oscillation than presurgery subjects. The results also indicated that both groups (control and scoliosis) showed more oscillation among those subjects with feet apart and eyes closed, but subjects with scoliosis were more affected by vision deprivation than by a reduced support base. Our results indicate that adolescents with idiopathic scoliosis are more dependent on visual information and that surgical correction does not change this relationship

  3. An observational study on surgically treated adult idiopathic scoliosis patients' quality of life outcomes at 1- and 2-year follow-ups and comparison to controls.

    PubMed

    Theis, Jennifer C; Grauers, Anna; Diarbakerli, Elias; Savvides, Panayiotis; Abbott, Allan; Gerdhem, Paul

    2017-01-01

    Prospective data on health-related quality of life in patients with idiopathic scoliosis treated surgically as adults is needed. We compared preoperative and 1- and 2-year follow-up data in surgically treated adults with idiopathic scoliosis with juvenile or adolescent onset. Results were compared to untreated adults with scoliosis and population normative data. A comparison of preoperative and 1- and 2-year follow-up data of 75 adults surgically treated for idiopathic scoliosis at a mean age of 28 years (range 18 to 69) from a prospective national register study, as well as a comparison with age- and sex-matched data from 75 untreated adults with less severe scoliosis and 75 adults without scoliosis, was made. Outcome measures were EuroQol-5 dimensions (EQ-5D) and Scoliosis Research Society (SRS)-22r questionnaire. In the surgically treated, EQ-5D and SRS-22r scores had statistically significant improvements at both 1- and 2-year follow-ups (all p  < 0.015). The effect size of surgery on EQ-5D at 1-year follow-up was large (r = -0.54) and small-medium (r = -0.20) at 2-year follow-up. The effect size of surgery on SRS-22r outcomes was medium-large at 1- and 2-year follow-ups (r = -0.43 and r = -0.42 respectively). At the 2-year follow-up, the EQ-5D score and the SRS-22r subscore were similar to the untreated scoliosis group (p = 0.56 and p = 0.91 respectively), but lower than those in the adults without scoliosis (p < 0.001 for both comparisons). Adults with idiopathic scoliosis experience an increase in health-related quality of life following surgery at 2-year follow-up, approaching the health-related quality of life of untreated individuals with less severe scoliosis, but remain lower than normative population data.

  4. Screening for NOTCH3 gene mutations among 151 consecutive Korean patients with acute ischemic stroke.

    PubMed

    Choi, Jay Chol; Lee, Keun-Hwa; Song, Sook-Keun; Lee, Jung Seok; Kang, Sa-Yoon; Kang, Ji-Hoon

    2013-07-01

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disorder of cerebral small blood vessels caused by mutations in the NOTCH3 gene. The initial detection of CADASIL may be more difficult among Asian populations because common clinical phenotypes and neuroimaging findings are not frequently found in these populations. The purpose of this study was to screen the NOTCH3 gene for mutations among consecutive patients with acute ischemic stroke from our region in Korea. Between April 2008 and March 2009, 151 consecutive patients with acute ischemic stroke were screened for NOTCH3 mutations. All patients underwent a detailed clinical examination and structured interview for clinical symptoms and family history. We reviewed brain magnetic resonance imaging data from stroke patients to assess the severity of white-matter hyperintensity lesions, the number of cerebral microbleeds, and the number of lacunar infarctions. Polymerase chain reaction was used to screen exons 3, 4, 6, 11, and 18 of the NOTCH3 gene. Among 151 consecutive patients with acute ischemic stroke, 6 patients (4.0%; 95% confidence interval [CI] 0.9-7.1) possessed a NOTCH3 gene mutation. All patients exhibited the same R544C mutation in exon 11. Four of these 6 patients presented with large artery atherosclerosis. The prevalence of CADASIL in patients with neuroimaging features consistent with advanced small-vessel disease was 36.0% (95% CI 8.0-64.8). In this region, NOTCH3 gene mutations are frequently found in acute stroke patients who present with neuroimaging features consistent with advanced small-vessel disease. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Intense pulsed light treatment of 1,000 consecutive patients with facial vascular marks.

    PubMed

    Clementoni, Matteo Tretti; Gilardino, Patrizia; Muti, Gabriele F; Signorini, Massimo; Pistorale, Antonio; Morselli, Paolo G; Cavina, Carlo

    2006-01-01

    Facial teleangectasias or vascular marks often represent a very cosmetically detracting problem for the affected patient, who tries to cover the lesions by camouflage strategies. This study describes the response of these vascular lesions after an intense pulsed light source was used on 1,000 consecutive patients. Between October 1998 and April 2005, 1,000 consecutive patients with various skin types (Fitzpatrick I to IV) were treated with Photoderm VL. The average age of the patients was 47.1 years. These patients were subjected to a mean of 2.16 treatments (range, 1-9), then followed up 48 h, 72 h, 1 week, 3 weeks, and 1 month after each treatment. All the patients were followed up 2 months after the last treatment, and the percentage of clearance was assessed by comparison of pre- and posttreatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The final physicians-nurse evaluation also was recorded on the same form. Most of the patients (89.70%) experienced a clearance of 75% to 100%. The results appear to be correlated with operator experience, but not with lesion size, age, or skin type. Minimal adverse side effects occurred for 14.6% of the patients, but only for 6.76% of the treatments. The intense pulsed light source Photoderm VL can be considered a fast, safe, and effective treatment for facial teleangectasias or vascular marks.

  6. Effect of Surgical Approach on Pulmonary Function in Adolescent Idiopathic Scoliosis Patients: A Systemic Review and Meta-analysis.

    PubMed

    Lee, Andy C H; Feger, Mark A; Singla, Anuj; Abel, Mark F

    2016-11-15

    Systemic review and meta-analysis. To analyze the effect of spinal fusion and instrumentation for adolescent idiopathic scoliosis (AIS) on absolute pulmonary function test (PFTs). Pulmonary function is correlated with severity of deformity in AIS patients and studies that have analyzed the effect of spinal fusion and instrumentation on PFTs for AIS have reported inconsistent results. There is a need to analyze the effect of spinal fusion on PFTs with stratification by surgical approach. Our analysis included 22 studies. Cohen's d effect sizes were calculated for absolute PFT outcome measures with 95% confidence intervals (CI). Meta-analyses were performed at each postoperative time frame for six homogeneous surgical approaches: (i) combined anterior release and posterior fusion with instrumentation; (ii) combined video assisted anterior release and posterior fusion with instrumentation without thoracoplasty; (iii) posterior fusion with instrumentation without thoracoplasty; (iv) anterior fusion with instrumentation and without thoracoplasty; (v) video assisted anterior fusion with instrumentation without thoracoplasty; and (vi) any scoliosis surgery with additional thoracoplasty. Anterior spinal fusion with instrumentation, any scoliosis surgery with concomitant thoracoplasty, or video-assisted anterior fusion with instrumentation for AIS had similar absolute PFTs at their 2 year postoperative follow up compared with their preoperative PFTs (effect sizes ranging from -0.2-0.2 with all CI crossing "0"). Posterior spinal fusion with instrumentation (with or without an anterior release) demonstrated small to moderate increases in PFTs 2 years postoperatively (effect sizes ranging from 0.35-0.65 with all CI not crossing "0"). Anterior fusion with instrumentation, regardless of the approach, and any scoliosis surgery with concomitant thoracoplasty do not lead to significant change in pulmonary functions 2 year after surgery. Posterior spinal fusion with instrumentation

  7. Synthetic porous ceramic compared with autograft in scoliosis surgery. A prospective, randomized study of 341 patients.

    PubMed

    Ransford, A O; Morley, T; Edgar, M A; Webb, P; Passuti, N; Chopin, D; Morin, C; Michel, F; Garin, C; Pries, D

    1998-01-01

    We have evaluated the use of a synthetic porous ceramic (Triosite) as a substitute for bone graft in posterior spinal fusion for idiopathic scoliosis. In a prospective, randomised study 341 patients at five hospitals in the UK and France were randomly allocated either to autograft from the iliac crest or rib segments (171) or to receive Triosite blocks (170). All patients were assessed after operation and at 3, 6, 12 and 18 months. The two groups were similar with regard to all demographic and baseline variables, but the 184 treated in France (54%) had Cotrel-Dubouset instrumentation and the 157 treated in the UK usually had Harrington-Luque implants. In the Triosite group the average Cobb angle of the upper curve was 56 degrees, corrected to 24 degrees (57%). At 18 months, the average was 26 degrees (3% loss). In the autograft group the average preoperative upper curve of 53 degrees was corrected to 21 degrees (60%). At 18 months the mean curve was 25 degrees (8% loss). Pain levels after operation were similar in the two groups, being mild in most cases. In the Triosite group only three patients had problems of wound healing, but in the autograft group, 14 patients had delayed healing, infection or haematoma in the spinal wound. In addition, 15 autograft patients had pain at the donor site at three months. Seven had infections, two had haematoma and four had delayed healing. The haematological and serum biochemistry results showed no abnormal trends and no significant differences between the groups. There were no adverse events related to the graft material and no evidence of allergenicity. Our results suggest that Triosite synthetic porous ceramic is a safe and effective substitute for autograft in these patients. Histological findings on biopsy indicate that Triosite provides a favourable scaffolding for the formation of new bone and is gradually incorporated into the fusion mass.

  8. The prevalence of intraspinal anomalies in infantile and juvenile patients with "presumed idiopathic" scoliosis: a MRI-based analysis of 504 patients.

    PubMed

    Zhang, Wen; Sha, Shifu; Xu, Leilei; Liu, Zhen; Qiu, Yong; Zhu, Zezhang

    2016-04-27

    Though several studies have reported the incidence of intraspinal neural axis abnormalities in infantile and juvenile "presumed idiopathic" scoliosis, there has been a varying prevalence ranging from 11.1 to 26.0% based on a limited sample size. Therefore, such inconclusive findings have resulted in some questions on the MRI-associated role in the management of these patients. We aimed to investigate the prevalence and distribution of intraspinal anomalies in the infantile and juvenile patients with "presumed idiopathic" scoliosis and to explore the radiographic and clinical indicators with large sample size. A total of 504 infantile and juvenile patients diagnosed with "presumed idiopathic" scoliosis were examined for potentially-existing neural axis abnormalities by MRI. Patients were grouped into two cohorts according to the presence of neural axis abnormalities. Radiographic parameters including curve magnitude, curve pattern, location of apex, degree of thoracic kyphosis, and span of curve were recorded and compared between the two groups. The prevalence of the neural abnormalities between the infantile-age group and juvenile-age group was also compared. The student t test was used to evaluate the differences of continuous variables and the chi-square test was used to evaluate the difference of categorical variables. Fisher exact test was applied to detect the difference of the rate of intraspinal anomalies between the "infantile idiopathic scoliosis" and "juvenile idiopathic scoliosis" group. Involving the spinal cord, 94 patients (18.7%) were found to have a neural abnormality: Arnold-Chiari malformation alone in 43 patients, Arnold-Chiari malformation combined with syringomyelia in 18 patients, isolated syringomyelia in 13 patients, diastematomyelia in six patients, tethered cord combined with diastematomyelia in six patients, tethered cord alone in four patients, and other uncommon intraspinal abnormalities in the remaining four patients. Totally Arnold

  9. Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients.

    PubMed

    Koller, Heiko; Pfanz, Conny; Meier, Oliver; Hitzl, Wolfgang; Mayer, Michael; Bullmann, Viola; Schulte, Tobias L

    2016-02-01

    In adult scoliosis surgery (AS) delineation of risk factors contributing to failure is important to improve patient care. Treatment goals include deformity correction resulting in a balanced spine and horizontal lowest instrumented vertebra (LIV) in fusions not ending at S1. Therefore, the study objectives were to determine predictors for deformity correction, complications, revision surgery, and outcomes as well as to determine predictors of postoperative evolution of the LIV-take-off angle (LIV-TO) and symptomatic adjacent segment disease (ASD). The authors performed a retrospective analysis of 448 patients who had AS surgery. Patients' age averaged 51 years, BMI 26, and follow-up of 40 months. According to the SRS adult scoliosis classification, 51 % of patients had major lumbar curves, 24 % each with single thoracic or double major curves. 54 % of patients had stable vertebra at L5 and 34 % of patients had fusion to S1. The mean number of posterior fusion levels was eight and implant density 73 %. Among standard radiographic measures of deformity the LIV-TO was assessed on neutral and bending/traction-films (bLIV-TO). Clinical outcomes were assessed in 145 patients with degenerative-type AS using validated measures (ODI, COMI and SF-36). Prediction analysis was conducted with stepwise multiple regression analyses. Preoperative thoracic curve (TC) was 53° and 33° at follow-up. Preoperative lumbar curve (LC) was 43° and 24° at follow-up. Curve flexibility was low (TC 34 %/LC 38 %). TC-correction (38 %) was predicted by preoperative TC (r = 0.9) and TC-flexibility (r = 0.8). LC-correction (50 %) was predicted by preoperative LC (r = 0.8), LC-flexibility (r = 0.8) and screw density (r = 0.7). Preoperative LIV-TO was 18.2° and at follow-up 9.4° (p < 0.01). 20 % of patients had a non-union (18 % at L5-S1). The risk for non-union at L5-S1 increased with age (p = 0.04), low screw density (p = 0.03), and postoperative sagittal imbalance [(T9-tilt (p = 0.01), C7

  10. The adult scoliosis.

    PubMed

    Aebi, Max

    2005-12-01

    Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Adult scoliosis can be separated into four major groups: Type 1: Primary degenerative scoliosis, mostly on the basis of a disc and/or facet joint arthritis, affecting those structures asymmetrically with predominantly back pain symptoms, often accompanied either by signs of spinal stenosis (central as well as lateral stenosis) or without. These curves are often classified as "de novo" scoliosis. Type 2: Idiopathic adolescent scoliosis of the thoracic and/or lumbar spine which progresses in adult life and is usually combined with secondary degeneration and/or imbalance. Some patients had either no surgical treatment or a surgical correction and fusion in adolescence in either the thoracic or thoracolumbar spine. Those patients may develop secondary degeneration and progression of the adjacent curve; in this case those curves belong to the type 3a. Type 3: Secondary adult curves: (a) In the context of an oblique pelvis, for instance, due to a leg length discrepancy or hip pathology or as a secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction; (b) In the context of a metabolic bone disease (mostly osteoporosis) combined with asymmetric arthritic disease and/or vertebral fractures. Sometimes it is difficult to decide, what exactly the primary cause of the curve was, once it has significantly progressed. However, once an asymmetric load or degeneration occurs, the pathomorphology and pathomechanism in adult scoliosis predominantly located in the lumbar or thoracolumbar spine is quite predictable. Asymmetric degeneration leads to increased asymmetric load and therefore to a progression of the degeneration and deformity, as either scoliosis and/or kyphosis. The progression of a curve is further supported by osteoporosis, particularly in post-menopausal female

  11. SRS-22r Scores in Nonoperated Adolescent Idiopathic Scoliosis Patients With Curves Greater Than Forty Degrees.

    PubMed

    Ward, W Timothy; Friel, Nicole A; Kenkre, Tanya S; Brooks, Maria M; Londino, Joanne A; Roach, James W

    2017-08-15

    Case control comparative series. Describe surgical range adolescent idiopathic scoliosis (AIS) patients electing to forgo surgery and compare health-related quality-of-life outcomes to a similar cohort of operated AIS patients by the same single surgeon. No data have been published either documenting SRS-22r scores of nonoperated patients with curves ≥40° or comparing these scores to a demographically similar operated cohort. Individuals with curves ≥40°, age ≥18 years, and electing to forgo surgery were identified. All patients completed an SRS-22r questionnaire. This nonoperated cohort's SRS-22r scores were compared to those of a large demographically similar cohort operated by the same surgeon. Group differences between the SRS-22r scores were evaluated by comparing these to published Minimal Clinically Important Differences (MCID) for the SRS-22r. One hundred ninety subjects with nonoperated curves were compared to 166 individuals who underwent surgery. The nonoperated cohort averaged 23.5 years of age, averaged 7.7 years since curve reached 40°, and had an average 50° Cobb angle at last follow-up. No statistical significant differences were found between the groups on the Pain, Function, or Mental Health domains of the SRS-22r. Statistically significant differences in favor of the operative cohort were found for self-image, satisfaction, and total score. The observed group differences did not meet the established thresholds for minimal clinically important differences in any of the domain scores, the average total score, or raw scores. There are no meaningful clinically significant differences in SRS-22r scores at average 8-year follow-up between AIS patients with curves ≥40° treated with or without surgery. These data in conjunction with an absence of long-term evidence of serious medical consequences with nonsurgical management of curves ≥40° should encourage surgeons to reevaluate the benefits of routine surgical care. 3.

  12. Effect of medical x-ray exposure on subsequent reproductive outcomes in scoliosis patients

    SciTech Connect

    Visscher, W.A.

    1987-01-01

    A retrospective cohort study was done which was designed to assess the effects of medical x-ray exposure on cancer incidence among scoliosis patients. Although the primary purpose of the study was to assess cancer incidence, a secondary goal was to investigate whether diagnostic x-ray exposure is related to adverse reproductive events in the female subjects. A series of case-control analyses were done which were designed to assess these effects. Radiation exposure was measured both by total films received and by an estimate of the number of films received and by an estimate of the number of films which involved ovarian irradiation. Radiation appeared to increase a woman's risk of any adverse event in the overall analysis and her risk of a premature or low birth weight infant in the separate analyses. Radiation did not appear to be related to spontaneous abortion, complications of pregnancy or delivery or birth defects, although the results of the pregnancy complications analysis was suggestive.

  13. Quantifying torso deformity in scoliosis

    NASA Astrophysics Data System (ADS)

    Ajemba, Peter O.; Kumar, Anish; Durdle, Nelson G.; Raso, V. James

    2006-03-01

    Scoliosis affects the alignment of the spine and the shape of the torso. Most scoliosis patients and their families are more concerned about the effect of scoliosis on the torso than its effect on the spine. There is a need to develop robust techniques for quantifying torso deformity based on full torso scans. In this paper, deformation indices obtained from orthogonal maps of full torso scans are used to quantify torso deformity in scoliosis. 'Orthogonal maps' are obtained by applying orthogonal transforms to 3D surface maps. (An 'orthogonal transform' maps a cylindrical coordinate system to a Cartesian coordinate system.) The technique was tested on 361 deformed computer models of the human torso and on 22 scans of volunteers (8 normal and 14 scoliosis). Deformation indices from the orthogonal maps correctly classified up to 95% of the volunteers with a specificity of 1.00 and a sensitivity of 0.91. In addition to classifying scoliosis, the system gives a visual representation of the entire torso in one view and is viable for use in a clinical environment for managing scoliosis.

  14. Conservative treatment of idiopathic scoliosis according to FITS concept: presentation of the method and preliminary, short term radiological and clinical results based on SOSORT and SRS criteria

    PubMed Central

    2011-01-01

    Background Conservative scoliosis therapy according to the FITS Concept is applied as a unique treatment or in combination with corrective bracing. The aim of the study was to present author's method of diagnosis and therapy for idiopathic scoliosis FITS-Functional Individual Therapy of Scoliosis and to analyze the early results of FITS therapy in a series of consecutive patients. Methods The analysis comprised separately: (1) single structural thoracic, thoracolumbar or lumbar curves and (2) double structural scoliosis-thoracic and thoracolumbar or lumbar curves. The Cobb angle and Risser sign were analyzed at the initial stage and at the 2.8-year follow-up. The percentage of patients improved (defined as decrease of Cobb angle of more than 5 degrees), stable (+/- 5 degrees), and progressed (increase of Cobb angle of more than 5 degrees) was calculated. The clinical assessment comprised: the Angle of Trunk Rotation (ATR) initial and follow-up value, the plumb line imbalance, the scapulae level and the distance from the apical spinous process of the primary curve to the plumb line. Results In the Group A: (1) in single structural scoliosis 50,0% of patients improved, 46,2% were stable and 3,8% progressed, while (2) in double scoliosis 50,0% of patients improved, 30,8% were stable and 19,2% progressed. In the Group B: (1) in single scoliosis 20,0% of patients improved, 80,0% were stable, no patient progressed, while (2) in double scoliosis 28,1% of patients improved, 46,9% were stable and 25,0% progressed. Conclusion Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish. PMID:22122964

  15. Two-stage vertebral column resection for severe and rigid scoliosis in patients with low body weight.

    PubMed

    Zhou, Chunguang; Liu, Limin; Song, Yueming; Liu, Hao; Li, Tao; Gong, Quan

    2013-05-01

    To date, there are no clinical series documenting the treatment of severe and rigid scoliosis in patients with low body weight. To optimize curve correction and minimize the risk of complications, we performed a two-stage vertebral column resection (VCR) with posterior pedicle screw instrumentation to treat patients with severe and rigid scoliosis and low body weight. The purposes of this study were to report the results of a two-staged VCR for patients with severe and rigid scoliosis and low body weight. This was a prospective, longitudinal, and descriptive study with a minimum follow-up of 2 years. Sixteen patients (nine women and seven men) with severe and rigid scoliosis and low body weight from the department of orthopedics, West China hospital, Sichuan University. Clinical analysis included rib hump and lumbar hump. Radiographic analysis consisted of Cobb angle measurements of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis. All measurements were taken before surgery, after surgery, and in the final follow-up period. For evaluation of surgical effectiveness, comparative analysis of rib hump, lumbar hump, Cobb angle of coronal curves, apical vertebral translation, coronal balance, sagittal balance, thoracic kyphosis, and lumbar lordosis before operation, after operation, and at the most recent follow-up was done. The body weight of patients averaged 33.8 kg (range 27-40 kg). Mean operating time was 580.3 minutes, with a blood loss of 1,581.3 mL. The correction rates of rib hump and lumbar hump were 77% and 85%. Preoperative major curves ranged from 90° to 130° Cobb angle. Coronal plane correction of the major curve averaged 70.7%, with an average loss of correction of 1.8%. The apical vertebral translation of the major curve was corrected by 73.2%. The preoperative coronal imbalance of 0.6 cm (range 0-1.4 cm) was improved to 0.5 cm (range 0-1.4 cm) at the most recent follow-up. The

  16. Preoperative and postoperative sagittal plane analysis in adult idiopathic scoliosis in patients older than 40 years of age.

    PubMed

    Sánchez-Mariscal, Felisa; Gomez-Rice, Alejandro; Rodríguez-López, Tamara; Zúñiga, Lorenzo; Pizones, Javier; Núñez-García, Ana; Izquierdo, Enrique

    2017-01-01

    Most of the papers correlate sagittal radiographic parameters with health-related quality of life (HRQOL) scores for patients with scoliosis. However, we do not know how changes in sagittal profile influence clinical outcomes after surgery in adult population operated for mainly frontal deformity. This study aimed to analyze spinal sagittal profile in a population operated on adult idiopathic scoliosis (AS) and to describe variations in sagittal parameters after surgery and the association between those variations and clinical outcomes. This is a historical cohort study. We included in this study 40 patients operated on AS, older than 40 at the time of surgery (mean age 54.9), and with more than 2-year follow-up (mean 7.4 years). Full-length free-standing radiographs, Scoliosis Research Society 22 (SRS22) and Short Form 36 (SF36) instruments, and satisfaction with outcomes were available at final follow-up. Sagittal preoperative and final follow-up radiographic parameters, radiographic correlation with HRQOL scores at final follow-up, and association between satisfaction and changes in sagittal profile were analyzed. A multivariate analysis was performed. No funds were received for this article. Preoperatively, the spinal sagittal plane tended to exhibit kyphosis. Most sagittal parameters did not improve at final follow-up with respect to preoperative values. We saw, after univariate analysis, that worse sagittal profile leads to worse HRQOL, but after multivariate analysis, only spinal tilt (ST) persisted as possible predictor for worse SRS activity scores. Frontal Cobb significantly improved. Most patients (82%) were satisfied with final outcomes. Variations in sagittal profile parameters did not differ between satisfied and dissatisfied patients. Although most sagittal plane parameters did not improve after surgery, surgical treatment in AS achieves a high satisfaction rate. Good clinical results do not correlate with improving sagittal plane parameters

  17. Cardiopulmonary function and scoliosis severity in idiopathic scoliosis children

    PubMed Central

    Huh, Seokwon; Kim, Nam Kyun; Jung, Jo Won; Choi, Jae Young; Kim, Hak Sun

    2015-01-01

    Purpose Idiopathic scoliosis is a structural lateral curvature of the spine of unknown etiology. The relationship between degree of spine curvature and cardiopulmonary function has not yet been investigated. The purpose of this study was to determine the association between scoliosis and cardiopulmonary characteristics. Methods Ninety children who underwent preoperative pulmonary or cardiac evaluation at a single spine institution over 41 months were included. They were divided into the thoracic-dominant scoliosis (group A, n=78) and lumbar-dominant scoliosis (group B, n=12) groups. Scoliosis severity was evaluated using the Cobb method. In each group, relationships between Cobb angles and cardiopulmonary markers such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, left ventricular ejection fraction, pulmonary artery flow velocity, and tissue Doppler velocities (E/E', E'/A') were analyzed by correlation analysis linear regression. Results In group A, 72 patients (92.3%) underwent pulmonary function tests (PFTs), and 41 (52.6%) underwent echocardiography. In group B, 9 patients (75.0%) underwent PFT and 8 (66.7%) underwent echocardiography. Cobb angles showed a significant negative correlation with FVC and FEV1 in group A (both P<0.05), but no such correlation in group B, and a significant negative correlation with mitral E/A ratio (P<0.05) and tissue Doppler E'/A' (P<0.05) in group A, with a positive correlation with mitral E/A ratio (P<0.05) in group B. Conclusion Pulmonary and cardiac function was significantly correlated with the degree of scoliosis in patients with thoracic-dominant scoliosis. Myocardial diastolic function might be impaired in patients with the most severe scoliosis. PMID:26213550

  18. Size and location of ruptured intracranial aneurysms: consecutive series of 1993 hospital-admitted patients.

    PubMed

    Korja, Miikka; Kivisaari, Riku; Rezai Jahromi, Behnam; Lehto, Hanna

    2016-12-02

    OBJECTIVE Large consecutive series on the size and location of ruptured intracranial aneurysms (RIAs) are limited, and therefore it has been difficult to estimate population-wide effects of size-based treatment strategies of unruptured intracranial aneurysms. The authors' aim was to define the size and location of RIAs in patients diagnosed with subarachnoid hemorrhage due to aneurysm rupture in a high-volume academic center. METHODS Consecutive patients admitted to a large nonprofit academic hospital with saccular RIAs between 1995 and 2009 were identified, and the size, location, and multiplicity of RIAs were defined and reported by patient sex. RESULTS In the study cohort of 1993 patients (61% women) with saccular RIAs, the 4 most common locations of RIAs were the middle cerebral (32%), anterior communicating (32%), posterior communicating (14%), and pericallosal arteries (5%). However, proportional distribution of RIAs varied considerably by sex; for example, RIAs of the anterior communicating artery were more frequently found in men than in women. Anterior circulation RIAs accounted for 90% of all RIAs, and 30% of the patients had multiple intracranial aneurysms. The median size (measured as maximum diameter) of all RIAs was 7 mm (range 1-43 mm), but the size varied considerably by location. For example, RIAs of the ophthalmic artery had a median size of 11 mm, whereas the median size of RIAs of the pericallosal artery was 6 mm. Of all RIAs, 68% were smaller than 10 mm in maximum diameter. CONCLUSIONS In this large consecutive series of RIAs, 83% of all RIAs were found in 4 anterior circulation locations. The majority of RIAs were small, but the size and location varied considerably by sex. The presented data may be of help in defining effective prevention strategies.

  19. Combination antihypertensive therapy in clinical practice. The analysis of 1254 consecutive patients with uncontrolled hypertension.

    PubMed

    Petrák, O; Zelinka, T; Štrauch, B; Rosa, J; Šomlóová, Z; Indra, T; Turková, H; Holaj, R; Widimský, J

    2016-01-01

    The aim of the study was to analyze the clinical use of different types of combination therapy in a large sample of consecutive patients with uncontrolled hypertension referred to Hypertension Centre. We performed a retrospective analysis of combination antihypertensive therapy in 1254 consecutive patients with uncontrolled hypertension receiving at least triple-combination antihypertensive therapy. Among the most prescribed antihypertensive classes were renin-angiotensin blockers (96.8%), calcium channel blockers (82.5%), diuretics (82.0%), beta-blockers (73.0%), centrally acting drugs (56.0%) and urapidil (24.1%). Least prescribed were spironolactone (22.2%) and alpha-1-blockers (17.1%). Thiazide/thiazide-like diuretics were underdosed in more than two-thirds of patients. Furosemide was prescribed in 14.3% of patients treated with diuretics, while only indicated in 3.9%. Inappropriate combination therapy was found in 40.4% of patients. Controversial dual and higher blockade of renin-angiotensin system occurred in 25.2%. Incorrect use of a combination of two antihypertensive drugs with the similar mechanism of action was found in 28.1%, most commonly a combination of two drugs with central mechanism (13.5%). In conclusion, use of controversial or incorrect combinations of drugs in uncontrolled hypertension is common. Diuretics are frequently underdosed and spironolactone remains neglected in general practice. The improper combination of antihypertensive drugs may contribute to uncontrolled hypertension.

  20. Consecutive Measurements by Faecal Immunochemical Test in Quiescent Ulcerative Colitis Patients Can Detect Clinical Relapse.

    PubMed

    Hiraoka, Sakiko; Kato, Jun; Nakarai, Asuka; Takashima, Shiho; Inokuchi, Toshihiro; Takei, Daisuke; Sugihara, Yuusaku; Takahara, Masahiro; Harada, Keita; Okada, Hiroyuki

    2016-06-01

    We have reported that results of the quantitative faecal immunochemical test (FIT; haemoglobin concentrations in faeces measured using an antibody for human haemoglobin) effectively reflect the mucosal status of ulcerative colitis (UC). The aim of this study was to evaluate the predictability of flare-up in quiescent UC patients by consecutive FIT evaluation. Patients with UC who fulfilled the following criteria by index colonoscopy were enrolled: clinical remission; mucosal healing (Mayo endoscopic subscore 0); and negative FIT (less than 100ng/mL). These patients were followed up prospectively every 1-3 months by monitoring patient symptoms and FIT results between index and subsequent colonoscopies. The intervals between 2 colonoscopies (median 2.51 years) of 83 patients (49 males, median age at onset 34 years, median disease duration 9.74 years) were analysed. None of the 43 (52%) patients who maintained negative FIT throughout the observation period exhibited clinical relapse. On the other hand, 25/40 (63%) patients who showed positive conversion of FIT during the period experienced relapse. The cutoff FIT value of 450ng/mL could predict relapse with 73% positive predictive value and 96% negative predictive value. Moreover, positive conversion of FIT preceded occurrence of symptoms by 1 month or more in nearly one-third of patients with relapse. Consecutive measurements of FIT in quiescent UC patients who achieved mucosal healing with negative FIT would help identify patients with clinical relapse whose symptoms had not yet presented. Further investigations are required for more precise prediction of relapse with this modality. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  1. Pre- and postoperative spinopelvic sagittal balance in adolescent patients with lenke type 5 idiopathic scoliosis.

    PubMed

    Yang, Xi; Liu, Limin; Song, Yueming; Zhou, Chunguang; Zhou, Zhongjie; Wang, Lei; Wang, Liang

    2015-01-15

    A retrospective study. To investigate the preoperative spinopelvic sagittal alignment in Lenke 5 patients with adolescent idiopathic scoliosis (AIS), and analyze how it alters after posterior correction. The structural thoracolumbar or lumbar curve may change the local sagittal alignment thereby altering the sagittal balance in Lenke 5 patients with AIS. However, few studies have evaluated the spinopelvic sagittal alignment before and after the surgery in these patients. Forty-eight Lenke 5 patients with AIS who underwent posterior correction and fusion were included in this study. Preoperative and postoperative radiographs were reviewed measuring both the coronal and sagittal parameters. Three pelvic sagittal states (anteverted, normal, or retroverted) were evaluated according to the magnitude relationship of individual pelvic tilt with pelvic incidence (PI). Both the coronal and sagittal parameters between different pelvic sagittal states were compared. The alterations of these parameters by surgery would also be analyzed. The mean follow-up was 1.8 years. Preoperatively, the mean PI was 44.3° with a pelvic tilt of 4.1°. There was 48% patients showing the anteverted pelvis, whereas the remaining 52% showing normal. The patients with anteverted pelvis showed a smaller PI and more distal lower end vertebra than normal pelvis ones. Logistic regression analysis revealed PI (odds ratio [OR] = 0.62, P = 0.024) and lower end vertebra (OR = 2.1, P = 0.037) were significantly associated with the risk of developing anteverted pelvis. The pelvic tilt was significantly increased and 61% of patients with preoperative anteverted pelvis had recovered. Logistic regression analysis revealed PI (OR = 0.7, P = 0.034) and lower instrumented vertebra (OR = 6.5, P = 0.002) were significantly associated with the risk of postoperative uncovered of anteverted pelvis. Anteverted pelvis appears in almost half of Lenke 5 patients with AIS, especially in who have smaller PI or distal lower

  2. Prevalence of appropriate cardioverter-defibrillator shocks in 1038 consecutive patients with implantable cardioverter-defibrillators.

    PubMed

    Kruger, Adam; Aronow, Wilbert S; Lai, Hoang; Desai, Harit; Singla, Atul; Frishman, William H; Cohen, Martin; Sorbera, Carmine

    2009-01-01

    During a 33-month follow-up of 1038 consecutive patients who had implantable cardioverter-defibrillators, appropriate shocks occurred in 329 of 1038 patients (32%). Appropriate shocks occurred in 101 of 380 patients (27%) treated with beta-adrenergic blockers alone; in 31 of 95 patients (33%) treated with amiodarone alone; in 39 of 149 patients (26%) treated with beta-blockers plus amiodarone; in 11 of 28 patients (39%) treated with sotalol alone; and in 147 of 386 patients (38%) treated with no beta-blockers, amiodarone, or sotalol (P < 0.001 comparing patients treated with beta-adrenergic blockers alone with patients treated with no beta-blockers, amiodarone, or sotalol; and P < 0.01 comparing patients treated with beta-blockers plus amiodarone with patients treated with no beta-blockers, amiodarone, or sotalol). In conclusion, patients having implantable cardioverter-defibrillators should also be treated with beta-adrenergic blockers to reduce the frequency of appropriate shocks.

  3. Brace Success Is Related to Curve Type in Patients with Adolescent Idiopathic Scoliosis.

    PubMed

    Thompson, Rachel M; Hubbard, Elizabeth W; Jo, Chan-Hee; Virostek, Donald; Karol, Lori A

    2017-06-07

    Curve magnitude and skeletal maturity are important factors in determining the efficacy of bracing for the treatment of adolescent idiopathic scoliosis, but curve morphology may also affect brace success. The purpose of this study was to determine the influence of curve morphology on the response to bracing with a thoracolumbosacral orthosis (TLSO). A retrospective review of patients managed with an orthosis for the treatment of adolescent idiopathic scoliosis who were prospectively enrolled at the initiation of brace wear and followed through completion of bracing or surgery was performed. Inclusion criteria were main curves of 25° to 45° and a Risser stage of 0, 1, or 2 at the time of brace prescription. Compliance with bracing was measured with Maxim Integrated Thermochrons. Radiographs made at brace initiation, brace cessation, and final follow-up were used to retrospectively categorize curves with use of the modified Lenke (mLenke) classification system and more broadly to categorize them as main thoracic or main lumbar. The effect of morphology on outcome was evaluated using chi-square and Fisher exact tests. One hundred and sixty-eight patients were included. There was no difference in curve magnitude at the time of brace initiation (p = 0.798) or in average hours of daily brace wear (p = 0.146) between groups. The rate of surgery or progression of the curve to ≥50° was 34.5% (29 of 84) in mLenke-I curves, 54.5% (6 of 11) in mLenke-II curves, 29.4% (10 of 34) in mLenke-III curves, 17.6% (3 of 17) in mLenke-V curves, and 13.6% (3 of 22) in mLenke-VI curves. There were no mLenke-IV curves at the time of brace initiation. The rate of surgery or progression to ≥50° was 34.1% (44 of 129) in the combined thoracic group and 15.4% (6 of 39) in the combined lumbar group (p = 0.0277). In brace-compliant patients (>12.9 hours/day), the rate of surgery or progression to ≥50° was 30.3% (20 of 66) in main thoracic curves and 5.3% (1 of 19) in main lumbar curves

  4. Transtemporal management of temporal bone encephaloceles and CSF leaks: review of 56 consecutive patients.

    PubMed

    Kari, Elina; Mattox, Douglas E

    2011-04-01

    This report details our experience in the management of 56 consecutive patients with mastoid encephaloceles and cerebrospinal fluid (CSF) leaks. The majority were managed through the transmastoid route with temporalis fascia and calvarial bone graft. Among the patients operated on at least 18 months before analysis, there was a median follow-up of 54 months with no intracranial complications. The average body mass index (BMI) of patients with spontaneous CSF leaks was found to be statistically significantly greater than that of patients with CSF leaks with traumatic, infectious or iatrogenic etiologies. To investigate the long-term follow-up of patients with spontaneous, iatrogenic, and traumatic temporal bone encephaloceles and CSF leaks to determine the effectiveness of the repair, late intracranial complications, and recurrent lesions. This is a retrospective review from a tertiary care center of 56 consecutive patients managed with CSF otorrhea, encephaloceles, and spontaneous pneumocephalus. All patients were repaired through transtemporal, middle cranial fossa or combined approaches for extradural repair and bone grafting. Of the 56 consecutive cases, 12 had CSF otorrhea alone, 19 had encephaloceles, and 23 had both. Two patients presented with spontaneous pneumocephalus without CSF leak. Thirty-three patients had spontaneous onset of their lesion without any history of temporal bone surgery or trauma. The average BMI of patients with spontaneous CSF leaks was found to be greater than the average BMI of patients with CSF leaks due to traumatic, infectious or iatrogenic causes. This difference was found to be statistically significant. Six of these had either preceding or subsequent contralateral mastoid or anterior fossa (sphenoid, ethmoid) CSF leak. Intracranial pressure was evaluated in these cases and most underwent VP shunting to reduce their intracranial pressure. Sixteen cases followed previous mastoid surgery or chronic ear disease and seven were

  5. Perioperative complications of scoliosis surgery in patients with Duchenne muscular dystrophy and spinal muscular atrophy, focussing on wound healing disorders.

    PubMed

    Burow, Mareike; Forst, Raimund; Forst, Jürgen; Hofner, Benjamin; Fujak, Albert

    2017-06-01

    Patients with Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA), both neuromuscular diseases, sustain spinal scoliosis in the course of their disease. To reduce the concomitant major morbidity and to improve their quality of life, patients require surgical spine stabilization. This can lead to complications like respiratory, cardiac or neurological complications or wound healing disorders (WHD). To find out the different complexities and risk factors increasing the chance to develop a WHD, the inpatient database was analyzed. We performed a retrospective statistical study. Therefore, we analyzed the inpatient database of 180 patients (142 DMD and 38 SMA patients). The focus was on WHD. To figure out the risk factors leading to WHD, we conducted a logistic regression. Cardiac complications occurred most frequently, followed by pulmonary complications and neurological lesions. Fifty-seven out of 180 patients developed a WHD. In 23 cases the WHD was aseptic, in the other 34 cases dermal organisms, Pseudomonas species and intestinal organisms were responsible. By means of the logistic regression, we were able to identify two more risk factors, in addition to diagnosis and gender, for developing a WHD in our patients: the year of surgery and the direction of pelvic tilt. Most common complications following scoliosis surgery are respiratory and cardiac complications. WHD is a severe complication that implies a prolonged therapy. Some risk factors for developing WHD could be identified in this analysis. Specifically, these were the date of surgery and the direction of pelvic tilt.

  6. Intravitreal bevacizumab: safety of multiple doses from a single vial for consecutive patients.

    PubMed

    Ng, Danny S; Kwok, Alvin K H; Chan, Clement W; Li, Walton W T

    2012-12-01

    To report the incidence of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor and the safety profile of multiple doses of bevacizumab from the same vial reused for multiple patients. Case series. A private hospital in Hong Kong. A systematic retrospective review of consecutive intravitreal anti-vascular endothelial growth factor injections between 5 June 2006 and 17 December 2010 at a single institute was conducted. Patients were identified from prospectively designed audit forms, and each patient's medical record was reviewed for any documented complications. Bevacizumab 1.25 mg/0.05 mL to 2.50 mg/0.1 mL was aspirated from the designated vial, with a maximum of 10 consecutive injections being aspirated from the same vial. The opened vial was then discarded without overnight storage. Ranibizumab was aspirated from the commercially available 1 mg/0.1 mL single-use vial. A total of 1655 intravitreal anti-vascular endothelial growth factor injections into 392 eyes of 383 patients were evaluated during the study period. There were 1184 bevacizumab injections and 471 ranibizumab injections. There was one case of suspected endophthalmitis after ranibizumab injection, though culture of the vitreous tap was negative. The point prevalence of endophthalmitis was 0.06% (1/1655) for the total number of injections: 0.21% (1/471) after ranibizumab, and 0% after bevacizumab. Although many centres aliquot multiple syringes from a single vial to be kept in a refrigerator for use, the current study shows that so long as proper sterile techniques are implemented, there were no cases of endophthalmitis from using the same vial, which was reused for a maximum of 10 consecutive injections. For intravitreal injection, bevacizumab costs approximately US$50 to US$100 per dose, as opposed to US$2000 per dose for ranibizumab. Sharing multiple doses of bevacizumab from a single vial can substantially reduce the cost of treatment.

  7. The clinical importance of sacral slanting in patients with adolescent idiopathic scoliosis undergoing surgery.

    PubMed

    Lee, Choon Sung; Ha, Jung-Ki; Kim, Dae Geun; Kim, Hyoungmin; Hwang, Chang Ju; Lee, Dong-Ho; Cho, Jae Hwan

    2015-05-01

    The phenomenon of sacral slanting has not been assessed in patients with adolescent idiopathic scoliosis (AIS). It could be important in determining distal fusion level. The purpose of this study is to clarify sacral slanting and to reveal frequency, character, and clinical importance of sacral slanting in AIS patients who underwent surgery. Retrospective review of radiographs. The study included 389 patients who underwent surgery for AIS at a single center. Slanted angles of sacrum, distal curve types, and postoperative decompensation were assessed in whole spine anteroposterior radiographs. This was a retrospective case series, which included 389 AIS patients who underwent corrective surgeries. The degree of sacral slanting was defined as the angle between the horizontal line and the upper end plate of the sacrum. Distal curves were classified according to the direction of L4 tilt (L4-left type and L4-right type). The frequency, direction, and relationship with curve types were analyzed descriptively. Postoperative changes of sacral slanting were compared by paired t test. Decompensation by distal fusion level and distal curve types was analyzed descriptively. The p value of less than .05 was considered as statistically significant. The frequency of sacral slanting was 19.5% (76 of 389), 29.6% (115 of 389), and 40.6% (158 of 389) by using criteria of 5°, 4°, and 3°, respectively. The 86.7% showed sacral slanting on the left side. The combination of L4-left type with left-sided sacral slanting was the most frequent (124 of 158, 78.7%). Slanted angles were decreased in some cases after surgery. Decompensation in the coronal plane was observed in 2 of 22 patients (9.1%) with a distal fusion level of L4 but in none of the 70 patients with a distal fusion level of L3. Sacral slanting in patients with AIS is a unique and frequently observed finding that has never been researched to date. Most importantly, sacral slanting is a critical consideration in selecting

  8. Radiographic Parameters in Adult Degenerative Scoliosis and Different Parameters Between Sagittal Balanced and Imbalanced ADS Patients.

    PubMed

    Yang, Changwei; Yang, Mingyuan; Chen, Yuanyuan; Wei, Xianzhao; Ni, Haijian; Chen, Ziqiang; Li, Jingfeng; Bai, Yushu; Zhu, Xiaodong; Li, Ming

    2015-07-01

    A retrospective study. To summarize and describe the radiographic parameters of adult degenerative scoliosis (ADS) and explore the radiological parameters which are significantly different in sagittal balanced and imbalanced ADS patients. ADS is the most common type of adult spinal deformity. However, no comprehensive description of radiographic parameters in ADS patients has been made, and few studies have been performed to explore which radiological parameters are significantly different between sagittal balanced and imbalanced ADS patients. Medical records of ADS patients in our outpatient clinic from January 2012 to January 2014 were reviewed. Demographic data including age and sex, and radiographic data including the coronal Cobb angle, location of apical vertebra/disc, convexity of the curve, degree of apical vertebra rotation, curve segments, thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar kyphosis (TL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), and PI minus LL (PI-LL) were reviewed to make comprehensive description of radiographic parameters of ADS. Furthermore, patients were divided into 2 groups according to whether the patients' sagittal plane was balanced: Group A (imbalanced, SVA > 5 cm) and Group B (balanced, SVA  ≤ 5 cm). Demographic and radiological parameters were compared between these 2 groups. A total of 99 patients were included in this study (Group A = 33 and Group B = 66; female = 83 and male = 16; sex ratio = 5:1). The median of age were 67 years (range: 41-92 years). The median of coronal Cobb angle and length of curve was 23 (range: 10-75°) and 5 segments (range: 3-7), respectively. The most common location of apical vertebra was at L2 to L3 (81%) and the median of degree of apical vertebra rotation was 2° (range: 1-3). Our study also showed significant correlations between coronal Cobb angle and curve segments (r = 0.23, P < 0.005) and degree of apical vertebra rotation (r

  9. One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation.

    PubMed

    Ravesloot, Madeline J L; de Vries, Nico

    2011-12-01

    Polysomnography (PSG) is mandatory in the diagnostic workup of obstructive sleep apnea (OSA); drug-induced sleep endoscopy (DISE) is a valid addition. DISE is a dynamic, safe, easy-to-perform technique that visualizes the anatomic sites of snoring or apneas and guides the making of a tailor-made treatment plan in individual cases. The aim of this prospective study was to document the results of 100 consecutive DISE procedures and investigate associations between PSG and DISE findings. This prospective, single-center, observational study enrolled 100 consecutive patients between June and August 2010. All 100 patients eligible for sleep surgery or a mandibular repositioning appliance (MRA) underwent PSG and DISE (using midazolam or propofol). DISE findings were reported using the VOTE classification system; site, degree of airway narrowing, and configuration of obstruction were reported. Associations were analyzed between PSG results, patient characteristics, and DISE findings. Our results suggest that a multilevel collapse, a complete collapse, and a tongue-base collapse are statistically significantly associated with higher apnea hypopnea index values. A tongue base collapse or epiglottal collapse is associated with positional OSA. Complete concentric collapse is statistically significantly associated with an increased body mass index. The results of this small-scale study help us understand the pathogenesis of OSA and the various associations between PSG outcomes and DISE results, as well as assisting the sleep surgeon in tailoring surgery for the patient. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  10. Center of gravity and radiographic posture analysis: a preliminary review of adult volunteers and adult patients affected by scoliosis.

    PubMed

    El Fegoun, Abdelkrim Benchikh; Schwab, Frank; Gamez, Lorenzo; Champain, Nicolas; Skalli, Wafa; Farcy, Jean-Pierre

    2005-07-01

    This is a prospective radiographic and force plate analysis involving adult volunteer and patients with scoliosis. To assess accurately the center of pressure in standing volunteers and patients with scoliosis, and correlate these finding with radiographic data. A simple and commonly applied parameter of global balance is the plumbline offset. This radiographic measurement refers to the center of C2 (or C7) drawn vertically downward. Although this measurement is simple, it may not accurately reflect the balance of the spine. This study included adult volunteers (n = 41) and patients with scoliosis (n = 45). Full-length, freestanding spine radiographs were obtained with subjects on a force plate. Simultaneous assessment of the radiologic spinal posture and the floor projection of the center of pressure (gravity line) was possible. The latter was projected on the full spine images and correlated to common radiographic parameters. The position of the gravity line differed significantly from the plumbline in frontal and sagittal planes (P < 0.001). This difference was maintained in both study populations. The mean frontal plane alignment of the gravity line was consistently to the right of the plumbline. The mean sagittal plane alignment of the gravity in relation to the plumbline revealed an offset anteriorly. The data analysis of offsets between the gravity line and radiographic parameters revealed a frontal plane mean displacement of the gravity line to the right. In the sagittal plane, a highly significant lack of correlation between the gravity line and plumbline was noted. The plumbline represents a common and convenient visual display of apparent sagittal plane imbalance, but its value as a marker of true postural balance must be questioned.

  11. Predictors for 1-year mortality following hip fracture: a retrospective review of 465 consecutive patients.

    PubMed

    Heyes, G J; Tucker, A; Marley, D; Foster, A

    2017-02-01

    In Europe, trauma admissions and in particular hip fractures are on the rise. In recent years, health care systems have placed particular emphasis, including financial incentives, on delivering patients quickly and safely to surgery. At our unit, we have observed that hip fracture patients appear to be at significant risk of mortality even up to a year following injury. This study reviews a consecutive population of hip fracture patients to identify predictors of excess risk. Four hundred and sixty-five consecutive patients were treated over a 2-year period at our district general hospital with no ward-based orthogeriatricians. Follow-up was for 1 year following hip fracture admission. Statistical analysis of variables and their influence on 1-year mortality were performed by calculating odd's ratio (OR) using a logistic regression model and a p value <0.05 was considered statistically significant. Four patients were lost to follow-up, 18 patients (4.1 %) were managed conservatively, 16 were too unwell for surgery and their mortality rate at 1 year was 50 %. Following hip fracture, we found an overall 1-year mortality rate of 15.1 %. Patients with a time to surgery ≥36 h were at significantly increased risk of mortality even up to 1 year. We did not identify a further reduction in mortality in those operated on within 24 h. Raised ORs (p > 0.05) were found with increasing comorbidity, surgery type, independence on discharge, alcohol ingestion, history of smoking, readmission and several biochemical markers. Minimising mortality risk, even over the longer term, should begin on admission with prompt optimisation of any acute medical or biochemical abnormalities, followed by early surgery and intensive rehabilitation to maintain patients' functional independence.

  12. [Characteristics of neuromuscular scoliosis].

    PubMed

    Putzier, M; Groß, C; Zahn, R K; Pumberger, M; Strube, P

    2016-06-01

    Usually, neuromuscular scolioses become clinically symptomatic relatively early and are rapidly progressive even after the end of growth. Without sufficient treatment they lead to a severe reduction of quality of life, to a loss of the ability of walking, standing or sitting as well as to an impairment of the cardiopulmonary system resulting in an increased mortality. Therefore, an intensive interdisciplinary treatment by physio- and ergotherapists, internists, pediatricians, orthotists, and orthopedists is indispensable. In contrast to idiopathic scoliosis the treatment of patients with neuromuscular scoliosis with orthosis is controversially discussed, whereas physiotherapy is established and essential to prevent contractures and to maintain the residual sensorimotor function.Frequently, the surgical treatment of the scoliosis is indicated. It should be noted that only long-segment posterior correction and fusion of the whole deformity leads to a significant improvement of the quality of life as well as to a prevention of a progression of the scoliosis and the development of junctional problems. The surgical intervention is usually performed before the end of growth. A prolonged delay of surgical intervention does not result in an increased height but only in a deformity progression and is therefore not justifiable. In early onset neuromuscular scolioses guided-growth implants are used to guarantee the adequat development. Because of the high complication rates, further optimization of these implant systems with regard to efficiency and safety have to be addressed in future research.

  13. Adolescent Idiopathic Scoliosis

    PubMed Central

    Choudhry, Muhammad Naghman; Ahmad, Zafar; Verma, Rajat

    2016-01-01

    Background: Scoliosis refers to deviation of spine greater than 10 degrees in the coronal plane. Idiopathic Scoliosis is the most common spinal deformity that develops in otherwise healthy children. The sub types of scoliosis are based on the age of the child at presentation. Adolescent idiopathic scoliosis (AIS) by definition occurs in children over the age of 10 years until skeletal maturity. Objective: The objective of this review is to outline the features of AIS to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome. Method: A thorough literature search was performed using available databases, including Pubmed and Embase, to cover important research published covering AIS. Conclusion: AIS results in higher incidence of back pain and discontent with body image. Curves greater than 50 degrees in thoracic region and greater than 30 degrees in lumbar region progress at a rate of 0.5 to 1 degree per year into adulthood. Curves greater than 60 degrees can lead to pulmonary functional deficit. Therefore once the disease is recognized, effective treatment should be instituted to address the deformity and prevention of its long-term sequelae. PMID:27347243

  14. HRQoL assessment by SRS-30 for Chinese patients with surgery for Adolescent Idiopathic Scoliosis (AIS).

    PubMed

    Ng, Bobby Kin Wah; Chau, Wai-Wang; Hui, Chak-Na; Cheng, Po-Yin; Wong, Chau-Yuet; Wang, Bin; Cheng, Jack Chun Yiu; Lam, Tsz Ping

    2015-01-01

    Health-related quality of life (HRQoL) outcome questionnaire, Scoliosis Research Society (SRS)-30, had been well received since its establishment in 2003. Literatures from Asia on the use of SRS-30 mainly focused on the translation process and validation process, but not on measuring outcomes, particularly in the Chinese community. We carried out a prospective cohort study to evaluate the HRQoL of Chinese AIS adolescents with severe scoliosis after surgery. One hundred and four Chinese AIS patients with severe scoliosis undergoing posterior spinal fusion between 2009 and 2013 were recruited in this study. They completed SRS-30 questions before surgery, before hospital discharge, and at follow-up. Mean scores and percentages of individual scores in different domains, and composite scores in terms of subtotal and total scores were calculated referring to the scoring system. Gender-specific and period-specific descriptive analyses were described. Correlation of mean domain scores at the three time points were explored to look for any time-specific relationship. Linear regression analysis looking for potential risk factors on domain scores at different time points by gender were also carried out. Mean age was 16.28 at surgery, and 83.6% were female. Significant correlations between pre-op scores and scores after surgery were observed in function/activity domain (p=0.05) in males, and pain (p=0.04) and satisfaction with management (p=0.04) domains in females. No gender difference in all 5 domain scores at the 3 time points was found. Pre-op maximum Cobb angle and corrected angle were found to be risk factors on self-image, as well as satisfaction with management, in male and female patients. This is the first report on the evaluation of the clinical HRQoL outcomes of Chinese AIS patients with severe scoliosis after surgery. Medical professionals should pay attention to take care of the difference in personal perceptions of feelings between boys and girls. Special care

  15. Video-assisted thoracoscopic surgery in idiopathic scoliosis: evaluation of the learning curve.

    PubMed

    Son-Hing, Jochen P; Blakemore, Laurel C; Poe-Kochert, Connie; Thompson, George H

    2007-03-15

    Retrospective review of patients with idiopathic scoliosis who underwent same-day or staged anterior and posterior spinal fusion and segmental spinal instrumentation. Evaluation of our learning curve with video-assisted thoracoscopic surgery (VATS) with respect to operative time, blood loss, and complications in patients with idiopathic scoliosis. VATS is a minimally invasive alternative to thoracotomy in the management of idiopathic scoliosis. An increased or steep learning curve has been described in the initial application of this technique. We began performing VATS in 1998. We compared our first 25 consecutive VATS patients (Group 2) and subsequent 28 consecutive VATS patients (Group 3) to our previous 16 consecutive patients (Group 1) with a thoracotomy (1991-1998) for idiopathic scoliosis. Training at a sponsored regional course was obtained before performing our first VATS procedure. VATS allowed more disc to be excised in Group 2 (4.5 +/- 1, 5.7 +/- 1, and 4.4 +/- 1 discs in Group 1, Group 2, and Group 3, respectively) and significantly decreased the anterior operative time (215 +/- 33, 260 +/- 56, and 177 +/- 47 minutes) and time per individual disc excision (50 +/- 13, 47 +/- 12, and 41 +/- 12 minutes), while providing comparable correction of the thoracic deformity (67% +/- 12%, 66% +/- 10%, and 70% +/- 13% correction). There was no increase in estimated intraoperative anterior blood loss (228 +/- 213, 183 +/- 136, and 211 +/- 158 mL), estimated blood loss per disc excised (51 +/- 42, 34 +/- 29 and 48 +/- 37 mL), or complications in the VATS groups. Complications were primarily pulmonary and resolved with medical therapy. Postoperative chest tube drainage (855 +/- 397, 462 +/- 249, and 561 +/- 261 mL) and total perioperative anterior blood loss (1083 +/- 507, 647 +/- 309, and 773 +/- 308 mL) were significantly decreased in the VATS groups, but this was attributed to the use of Amicar. VATS is an effective procedure for anterior spinal fusion in

  16. Comparative Analysis of Interval, Skipped, and Key-vertebral Pedicle Screw Strategies for Correction in Patients With Lenke Type 1 Adolescent Idiopathic Scoliosis.

    PubMed

    Wang, Fei; Xu, Xi-Ming; Lu, Yanghu; Wei, Xian-Zhao; Zhu, Xiao-Dong; Li, Ming

    2016-03-01

    Pedicle screw constructs have become the mainstay for surgical correction in patients with spinal deformities. To reduce or avoid the risk of pedicle screw-based complications and to decrease the costs associated with pedicle screw instrumentation, some authors have introduced interval, skipped, and key-vertebral pedicle screw strategies for correction. However, there have been no comparisons of outcomes among these 3 pedicle screw-placement strategies.The aim of this study was to compare the correlative clinical outcomes of posterior correction and fusion with pedicle screw fixation using these 3 surgical strategies.Fifty-six consecutive patients with Lenke type 1 adolescent idiopathic scoliosis were included in this study. Twenty patients were treated with the interval pedicle screw strategy (IPSS), 20 with the skipped pedicle screw strategy (SPSS), and 16 with the key-vertebral pedicle screw strategy (KVPSS). Coronal and sagittal radiographs were analyzed before surgery, at 1 week after surgery, and at the last follow-up after surgery.There were no significant differences among the 3 groups regarding preoperative radiographic parameters. No significant difference was found between the IPSS and SPSS groups in correction of the main thoracic curve (70.8% vs 70.0%; P = 0.524). However, there were statistically significant differences between the IPSS and KVPSS groups (70.8% vs 64.9%) and between the SPSS and KVPSS groups (70.0% vs 64.9%) in correction of the main thoracic curve (P < 0.001 for both). Additionally, there were no significant differences among the 3 strategies for sagittal parameters at the immediate postoperative and last postoperative follow-up periods, though there were significant differences in the Cobb angle between the preoperative and immediate postoperative periods among the 3 groups, but not between the immediate postoperative and last follow-up periods. The amount of hospital charges in the SPSS group was significantly higher than

  17. Comparative Analysis of Interval, Skipped, and Key-vertebral Pedicle Screw Strategies for Correction in Patients With Lenke Type 1 Adolescent Idiopathic Scoliosis

    PubMed Central

    Wang, Fei; Xu, Xi-Ming; Lu, Yanghu; Wei, Xian-Zhao; Zhu, Xiao-Dong; Li, Ming

    2016-01-01

    Abstract Pedicle screw constructs have become the mainstay for surgical correction in patients with spinal deformities. To reduce or avoid the risk of pedicle screw-based complications and to decrease the costs associated with pedicle screw instrumentation, some authors have introduced interval, skipped, and key-vertebral pedicle screw strategies for correction. However, there have been no comparisons of outcomes among these 3 pedicle screw-placement strategies. The aim of this study was to compare the correlative clinical outcomes of posterior correction and fusion with pedicle screw fixation using these 3 surgical strategies. Fifty-six consecutive patients with Lenke type 1 adolescent idiopathic scoliosis were included in this study. Twenty patients were treated with the interval pedicle screw strategy (IPSS), 20 with the skipped pedicle screw strategy (SPSS), and 16 with the key-vertebral pedicle screw strategy (KVPSS). Coronal and sagittal radiographs were analyzed before surgery, at 1 week after surgery, and at the last follow-up after surgery. There were no significant differences among the 3 groups regarding preoperative radiographic parameters. No significant difference was found between the IPSS and SPSS groups in correction of the main thoracic curve (70.8% vs 70.0%; P = 0.524). However, there were statistically significant differences between the IPSS and KVPSS groups (70.8% vs 64.9%) and between the SPSS and KVPSS groups (70.0% vs 64.9%) in correction of the main thoracic curve (P < 0.001 for both). Additionally, there were no significant differences among the 3 strategies for sagittal parameters at the immediate postoperative and last postoperative follow-up periods, though there were significant differences in the Cobb angle between the preoperative and immediate postoperative periods among the 3 groups, but not between the immediate postoperative and last follow-up periods. The amount of hospital charges in the SPSS group was significantly

  18. Diagnosis and treatment of psychogenic erectile dysfunction in a urological setting: outcomes of 18 consecutive patients.

    PubMed

    Vickers, M A; De Nobrega, A M; Dluhy, R G

    1993-05-01

    The diagnostic criteria and treatment outcomes of 18 consecutive patients with psychogenic erectile dysfunction were examined. Average patient age was 38 years, and all patients had either awakening penile or masturbatory rigidity. Each patient was studied with home monitoring (ART-1000) on 2 consecutive nights. The average number of maximum erectile episodes, the event during which the maximum rigidity was maintained for at least 5 minutes, was 1.6. The maximum sleep erectile episodes averaged 11.2 minutes during which penile rigidity averaged 572 gm. The main predictor for remission of erectile dysfunction in this study was whether the dysfunction was primary or secondary. Of 14 patients with secondary psychogenic erectile dysfunction, that is history of being able to achieve and maintain penile rigidity sufficient for at least 5 minutes of vaginal intercourse, 10 (71%) experienced remission. Three patients noticed spontaneous remission during the initial evaluation and another 3 experienced remission within 3 months of completion of the evaluation and reassurance that they had normal erectile capacity. Two patients had remission while considering penile vascular surgery and in 2 normal erectile function returned during injection therapy. Only 2 of 3 patients referred for sex therapy actually received it (Freudian theory), and neither noticed improvement in erectile function. One patient received yohimbine without benefit. None of the patients elected treatment with the vacuum constriction device. All 4 patients with primary psychogenic erectile dysfunction, that is never able to achieve and/or maintain penile rigidity sufficient to achieve vaginal intercourse, failed to respond to physician reassurance and time. Of 2 patients who received sex therapy (1 Freudian and 1 behavioral) without improvement in erectile function 1 has entered the pharmacological erection program and has achieved vaginal penetration, and the other is considering the pharmacological

  19. Neuromuscular scoliosis.

    PubMed

    Allam, Anand M; Schwabe, Aloysia L

    2013-11-01

    The purpose of this focused review is to provide an overview of neuromuscular scoliosis from the perspective of the rehabilitation physician. Scoliosis is a common consequence of neuromuscular diseases, including central nervous system disorders such as cerebral palsy and spinal cord injury; motor neuron disorders, for example, spinal muscular atrophy; muscle fiber disorders, for example, Duchenne muscular dystrophy; multifactorial disorders, for example, spina bifida; and many other neuropathic and myopathic conditions. Unlike adolescent idiopathic scoliosis, which is the most common form of spinal deformity, neuromuscular scoliosis is more severe and more progressive, and is associated with more morbidity. Factors that contribute to this spinal deformity include asymmetric paraplegia, imbalance of mechanical forces, intraspinal and congenital anomalies of the spine, altered sensory feedback, and abnormal posture via central pathways. Spinal deformity combined with limitations due to an underlying neuromuscular condition lead to significant physiologic impairments that affect limb movement, cardiopulmonary function, gait, standing, sitting, balance, trunk stability, bimanual activities, activities of daily living, and pain, as well as concerns with self-image and social interactions. Evaluation and management of this population requires understanding of disease progression, pulmonary status, functional limitations, indications for conservative and surgical interventions, and social considerations.

  20. Posterior Spine Fusion with Moss-Miami Instrumentation for Adolescent Idiopathic Scoliosis: Radiographic, Clinical and Patient-Centered Outcomes

    PubMed Central

    Maio, Fernando De; Dolan, Lori A; Luna, Vincenzo De; Weinstein, Stuart L

    2007-01-01

    This paper evaluates the efficacy the Moss-Miami System instrumentation for surgical treatment of spinal deformity. Eight-five patients with AIS underwent a posterior spinal fusion with using this system between 1994 and 1998. Radiographs of the spine were taken preoperatively, at discharge, one year after surgery, and at the latest follow-up (average of 2.5 year, range 2 to 6 years). All radiographs were assessed for curve magnitude, coronal balance, kyphosis, lordosis, junctional kyphosis, and sagittal balance. The scoliosis research society instrument was administered at the final follow-up. the average curve correction ranged from 53 to 65 percent. All patients showed solid fusion by final follow-up. three patients required a second operation for complications related to their scoliosis; two patients showed a rod fracture without evidence of pseudoarthrosis or curve progression. Two transient neurological complications related to the surgery were observed. SRS results were favorable with regard to function and cosmetic appearance. PMID:17907427

  1. Lessons learned from two consecutive cleft lip and palate missions and the impact of patient education.

    PubMed

    Schönmeyr, Björn; Restrepo, Carolina; Wendby, Lisa; Gillenwater, Justin; Campbell, Alex

    2014-09-01

    Two consecutive cleft missions were conducted in Guwahati, northeastern India in December 2010 and January 2011. In the later mission, a standardized patient education program for postoperative care was introduced. The objective of this study was to retrospectively evaluate the impact of the patient education program on cleft lip complications in terms of wound infection and dehiscence. Two hundred ninety-eight cleft lip repairs were performed in the first mission and 220 (74%) returned for early follow-up. In the second mission, 356 patients were operated on and 252 (71%) returned for follow-up. From the first mission, 8 patients (3.7%) were diagnosed with lip wound infection and 21 patients (9.6%) with lip dehiscence. After the second mission, only 1 patient (0.4%) returned with a wound infection and 16 (6.4%) were diagnosed with dehiscence.Using binary logistic regression including age, cleft type, postoperative antibiotics, surgeon, and patient education program as covariates, the patient education program stood out as the only variable with a statistically significant impact on the incidence of postoperative wound infections. Even though the incidence of lip dehiscence was reduced by one third when the patient education program was utilized, our regression model singled out the surgeons as the only factor significantly related to this type of complication. Moreover, no benefits of postoperative antibiotic prophylaxis were found. Further analysis of the data also implied that the use of tissue adhesive as a compliment to sutures does not reduce the risk of dehiscence.

  2. The long-term outcome of patients treated operatively and non-operatively for scoliosis deformity secondary to spina bifida.

    PubMed

    Khoshbin, A; Vivas, L; Law, P W; Stephens, D; Davis, A M; Howard, A; Jarvis, J G; Wright, J G

    2014-09-01

    The purpose of this study was to evaluate the long-term outcome of adults with spina bifida cystica (SBC) who had been treated either operatively or non-operatively for scoliosis during childhood. We reviewed 45 patients with a SBC scoliosis (Cobb angle ≥ 50º) who had been treated at one of two children's hospitals between 1991 and 2007. Of these, 34 (75.6%) had been treated operatively and 11 (24.4%) non-operatively. After a mean follow-up of 14.1 years (standard deviation (sd) 4.3) clinical, radiological and health-related quality of life (HRQOL) outcomes were evaluated using the Spina Bifida Spine Questionnaire (SBSQ) and the 36-Item Short Form Health Survey (SF-36). Although patients in the two groups were demographically similar, those who had undergone surgery had a larger mean Cobb angle (88.0º (sd 20.5; 50.0 to 122.0) ; : versus 65.7º (sd 22.0; 51.0 to 115.0); p < 0.01) and a larger mean clavicle-rib intersection difference (12.3 mm; (sd 8.5; 1 to 37); versus 4.1 mm, (sd 5.9; 0 to 16); p = 0.01) than those treated non-operatively. Both groups were statistically similar at follow-up with respect to walking capacity, neurological motor level, sitting balance and health-related quality of life (HRQOL) outcomes. Spinal fusion in SBC scoliosis corrects coronal deformity and stops progression of the curve but has no clear effect on HRQOL. ©2014 The British Editorial Society of Bone & Joint Surgery.

  3. Risk Assessment of Lumbar Segmental Artery Injury During Lateral Transpsoas Approach in the Patients With Lumbar Scoliosis.

    PubMed

    Takata, Yoichiro; Sakai, Toshinori; Tezuka, Fumitake; Yamashita, Kazuta; Abe, Mitsunobu; Higashino, Kosaku; Ngamachi, Akihiro; Sairyo, Koichi

    2016-05-01

    A retrospective study using 27 contrast-enhanced multi-planar computed tomography scans of subjects with lumbar scoliosis. To assess the risk of injury of lumbar segmental arteries during transpsoas approach in patients with lumbar scoliosis. Although lumbar interbody fusion using big intervertebral cage through transpsoas approach has a big advantage to correct coronal and sagittal deformity in patients with spinal deformity, the risk for injury of lumbar segmental artery is always concerned. The abdominal-contrast enhanced multi-planar computed tomography scans of 27 subjects with lumbar scoliosis with over 15° of Cobb angle were retrospectively reviewed. The coronal views through the posterior one third of the intervertebral discs were reviewed. The cranio-caudal intervals of the adjacent segmental arteries at each intervertebral level were measured. The recommended working space for the lateral transpsoas approach using extreme lateral interbody fusion retractor is 24 mm in the cranio-caudal direction. The cutoff value for an intersegmental Cobb angle that would estimate a cranio-caudal interval of less than 24 mm was determined using a receiver operating characteristic curve. The average interval between the cranio-caudal lumbar segmental arteries on the concave side was significantly shorter than that on the convex side (29.9 vs. 33.6 mm, P < 0.05). The differences in the intervals between the convex and concave sides were correlated with the corresponding intersegmental Cobb angle (r = 0.65, P < 0.05). Receiver operating characteristic curve analysis revealed that cutoff value for the best prediction of an interval less than 24 mm was 14.5°, with a specificity of 94.3% and sensitivity of 71.4%. This study demonstrated that female patients with lumbar scoliosis with an intersegmental Cobb angle higher than 14.5° would be at high risk for potential injury to the lumbar artery during a transpsoas approach for extreme lateral interbody

  4. Temporomandibular joint osseous morphology in a consecutive sample of ankylosing spondylitis patients

    PubMed Central

    Ramos-Remus, C.; Major, P.; Gomez-Vargas, A.; Petrikowski, G.; Hernandez-Chavez, A.; Gonzalez-Marin, E.; Russell, A.

    1997-01-01

    OBJECTIVE—To evaluate temporomandibular joint (TMJ) osseous morphology in a consecutive sample of Mexican patients with ankylosing spondylitis.
METHODS—Consecutive patients with a diagnosis of ankylosing spondylitis who attended two secondary care outpatient rheumatology clinics were included in the study. Patients had a rheumatological assessment using a structured questionnaire and examination. Recorded variables included demographic data, disease characteristics, TMJ symptoms, and axial mobility measurements. Hypocycloidal tomography of the TMJ was obtained on all subjects. Radiographic variables included condyle position, superior joint space, range of movement, condylar osseous changes, and temporal osseous changes. Patients also underwent standard cervical spine radiography. A control group of normal people without either TMJ symptoms or systemic rheumatic disease was obtained.
RESULTS—65 subjects were studied (65 right sided and 63 left sided tomograms). The control group consisted of 22 individuals. Both groups were similar in age [33 (SD 11) v 34 (9) years, P = 0.8]. Patients with ankylosing spondylitis had more variability in TMJ mobility than controls (P < 0.05) and showed increased frequency of condylar erosions (P < 0.01), flattening (P < 0.01), sclerosis (P < 0.01), and temporal flattening (P < 0.01). Condylar erosions were associated with longer duration of ankylosing spondylitis (P < 0.05), neck complaints (P < 0.05), and atlantoaxial subluxation (P < 0.05).
CONCLUSIONS—TMJ involvement is frequent in this population of patients with ankylosing spondylitis and is associated with variables that suggest more severe disease.

 PMID:9068282

  5. Provisional stenting in the real world: results in 1058 consecutive patients undergoing percutaneous coronary angioplasty.

    PubMed

    Ten Berg, Jurriën M; Kelder, Johannes C; Suttorp, Maarten Jan; Plokker, Thijs HW

    2001-09-01

    OBJECTIVE: To study a strategy of aggressive coronary balloon angioplasty with provisional stenting in allcomers. In randomized trials, stenting has improved the outcome of patients undergoing coronary intervention. However, whether these results hold up in clinical practice is largely unknown. Furthermore, the results of balloon angioplasty have also improved dramatically. It is therefore essential to evaluate the current results of balloon angioplasty and to assess whether stents are required in all patients. METHODS: The authors prospectively studied the occurrence of death, myocardial infarction (MI) and target lesion revascularization (TLR) of a large consecutive group of patients undergoing aggressive balloon angioplasty with provisional stenting. None of the patients received a platelet glycoprotein IIb/IIIa receptor blocker. The results were compared with the outcome of routine stenting in recent randomized trials. RESULTS: Angioplasty was performed in 1058 patients of whom 369 (34.9%) received a stent. The angiographic success rate was 98.9%. During hospital stay, 4.8% of the patients suffered any cardiac event. At one-year follow-up, death occurred in 1.1%, MI in 3.3%, TLR in 12.4% and any event in 16.7% of the patients. Event-free survival at one-year was 82.3%. These results compare favorably with routine stenting in recent trials. CONCLUSIONS: Aggressive balloon angioplasty with provisional stenting yields excellent results in a general patient population.

  6. Scoliosis and interspinous decompression with the X-STOP: prospective minimum 1-year outcomes in lumbar spinal stenosis.

    PubMed

    Rolfe, Kevin W; Zucherman, James F; Kondrashov, Dimitriy G; Hsu, Ken Y; Nosova, Emily

    2010-11-01

    The X-STOP interspinous decompression device, as a treatment for neurogenic intermittent claudication (NIC) because of lumbar spinal stenosis (LSS), has been shown to be superior to nonoperative control treatment. Current Food and Drug Administration labeling limits X-STOP use to NIC patients with a maximum of 25° concomitant lumbar scoliosis. This value was arrived at arbitrarily by the device developers and is untested. To determine X-STOP utility for NIC in patients with concomitant lumbar scoliosis. A prospective, single institution, clinical outcome study comparing patients with scoliosis with patients without scoliosis who underwent X-STOP interspinous decompression for NIC because of LSS. A cohort of 179 consecutive patients, 63 with scoliosis (Cobb angle 11° or more) and 116 without scoliosis, with symptoms attributable to NIC treated between January 2006 and May 2007, were included in the study. All patients completed self-reported preoperative and minimum 1-year postoperative outcome forms. Functional measures included Oswestry Disability Index (ODI), visual analog scale (VAS) pain score, and maximum walking and standing times in minutes. Three questions measured patient satisfaction: How satisfied were you with the procedure (very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied); Would you have the procedure again? (yes or no); Would you recommend the procedure to a friend? (yes or no). Before analysis, the 179 consecutive X-STOP patients were divided into three groups: Group 1 (controls without scoliosis, n=116); Group 2 (low scoliosis: 11-25°, n=41), and Group 3 (high scoliosis: 26° or more, n=22). The three groups were not statistically different for any preoperative functional scores. Groups were analyzed for pre- to postoperative functional change and level of satisfaction. Segmental scoliosis at the treated level was also analyzed. Fifty-six percent of Group 1 and Group 2 patients, but only 18% of Group 3 patients

  7. [State temperature-pain sensitivity and morphological features of the skin back in patients with idiopathic scoliosis with stage III-IV].

    PubMed

    Gorbach, E N; Shchurova, E N; Kobyzev, A E; Ryabykh, S O; Ochirova, P V

    2015-03-01

    This study was aimed at revealing the features condition of thermal, pain sensitivity and morphological pattern of the skin of the human back at the apex of spinal deformity in the thoracic area in patients with idiopathic scoliosis with stage III-IV. The study included 41 adolescent with idiopathic scoliosis with stage III-IV. Temperature-pain sensitivity was studied in Th6-Th10 dermatomes on the right and the left. Biopsies (skin) for histological examination were taken intraoperatively in projection corresponding to the apex of the arc scoliosis of the spine. Significant disorders of the sensitivity to temperature and pain were found in the dermatomes to the apex of the thoracic spine deformity that were hyperesthesia, hypoesthesia, or absent thermal sensitivity. Histostrukturnye changes of the skin are significantly decreasing the thickness of the epidermis and dermis, reduction of capillaries and changing the structure of the small vessels, destruction of individual nerve fibers and free nerve endings.

  8. The prevalence of self-harm behaviors in a consecutive sample of cardiac stress test patients.

    PubMed

    Sansone, Randy A; Dittoe, Nathaniel; Hahn, Harvey S; Wiederman, Michael W

    2011-01-01

    While self-harm behavior has been studied in various psychiatric populations, particularly the behaviors of suicide attempts and completions, little empirical data exists on the lifetime prevalence of various self-harm behaviors in non-psychiatric populations. In the present study, using a cross-sectional approach and a self-report survey methodology, we examined the lifetime prevalence of 22 self-harm behaviors in a consecutive sample of 250 patients undergoing cardiac stress testing. Results indicated that abuse alcohol was most common (17.2%) followed by promiscuity (10.4%); 6% reported a previous suicide atatempt. Findings indicate areas of clinician inquiry for self-harm behaviors in non-psychiatric patients.

  9. [Primary angioplasty in acute myocardial infarct. A report on 304 consecutive patients].

    PubMed

    García y Otero, J M; Frutos Rangel, E; García García, R; Fernández Valadez, E; Zúñiga Sedano, J; Orendain González, V M; Briseño Ramírez, H

    1998-01-01

    The purpose of this study is to describe a single-center experience in primary coronary angioplasty in 304 consecutive patients with acute myocardial infarction. Sixty-seven percent were men and 33% women, the mean age was 69 years. The time from onset to treatment was 3.5 hours, 14% had previous bypass surgery and 23% prior myocardial infarction, 11% arrived in cardiogenic shock. Coronary angiography showed multivessel disease in 56% of patients, 73% had TIMI 0-1 flow. Successful PTCA occurred in 95% and in hospital mortality was 6.5%. Primary coronary angioplasty is a successful reperfusion method in acute myocardial infarction and it is associated with low mortality even in high risk groups. The rates of success and major complications in this series are similar to other publications.

  10. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population.

    PubMed

    Schwab, Frank; Dubey, Ashok; Gamez, Lorenzo; El Fegoun, Abdelkrim Benchikh; Hwang, Ki; Pagala, Murali; Farcy, J-P

    2005-05-01

    A prospective self-assessment analysis and evaluation of nutritional and radiographic parameters in a consecutive series of healthy adult volunteers older than 60 years. To ascertain the prevalence of adult scoliosis, assess radiographic parameters, and determine if there is a correlation with functional self-assessment in an aged volunteer population. There exists little data studying the prevalence of scoliosis in a volunteer aged population, and correlation between deformity and self-assessment parameters. There were 75 subjects in the study. Inclusion criteria were: age > or =60 years, no known history of scoliosis, and no prior spine surgery. Each subject answered a RAND 36-Item Health Survey questionnaire, a full-length anteroposterior standing radiographic assessment of the spine was obtained, and nutritional parameters were analyzed from blood samples. For each subject, radiographic, laboratory, and clinical data were evaluated. The study population was divided into 3 groups based on frontal plane Cobb angulation of the spine. Comparison of the RAND 36-Item Health Surveys data among groups of the volunteer population and with United States population benchmark data (age 65-74 years) was undertaken using an unpaired t test. Any correlation between radiographic, laboratory, and self-assessment data were also investigated. The mean age of the patients in this study was 70.5 years (range 60-90). Mean Cobb angle was 17 degrees in the frontal plane. In the study group, 68% of subjects met the definition of scoliosis (Cobb angle >10 degrees). No significant correlation was noted among radiographic parameters and visual analog scale scores, albumin, lymphocytes, or transferrin levels in the study group as a whole. Prevalence of scoliosis was not significantly different between males and females (P > 0.03). The scoliosis prevalence rate of 68% found in this study reveals a rate significantly higher than reported in other studies. These findings most likely reflect

  11. Natural History of Untreated Scoliosis in beta-Thalassemia.

    PubMed

    Papanastasiou, Dimitris A; Ellina, Aikaterini; Baikousis, Andreas; Pastromas, Basilis; Iliopoulos, Panos; Korovessis, Panagiotis

    2002-06-01

    A prospective study was performed. To investigate the natural history of untreated scoliosis in beta-thalassemia patients in a 10-year period. Several previous studies have demonstrated the bone deformities, particularly the high incidence of scoliosis, that is associated with beta-thalassemia. However, little is known about the evolution of scoliosis curvatures, and almost nothing is known about the natural history of this type of scoliosis and its associated lateral spinal curvatures. From a group of 115 patients with beta-thalassemia who were evaluated for scoliosis 10 years ago, 43 patients (37%) were re-evaluated 10 years later to study the evolution of the untreated scoliosis and lateral spinal curvatures. Scoliosis, thoracic kyphosis, thoracolumbar kyphosis, and lumbar lordosis were measured both in the initial and last observation and were compared with each other. All changes in scoliosis curve location, direction, and rate of resolving, as well as the changes in the magnitude of the lateral spine curves, were recorded. Scoliosis curves of more than 5 degrees were present in 34 (79%) of the 43 patients who were followed. Scoliosis progressed but was not statistically significant in 12% of the patients with thalassemia in a 10-year span. Ten years ago, 12 patients (28%) showed scoliosis of 10 degrees to 14 degrees, whereas in the last evaluation, 15 patients (35%) had scoliosis of 10 degrees to 19 degrees. The S-shaped scoliosis curve pattern was the most common (29%). In 10 years, the scoliosis curve pattern remained unchanged in 38% of the patients, and it changed in 38%, whereas 24% of the minor curves (5-9 degrees ) showed spontaneous "self-resolving" character. In the last evaluation, there were seven patients (16%) with new cases of scoliosis de novo. There was no sex-related predominance in prevalence of scoliosis in this series. There was a significant skeletal mature retardation in the patients with beta-thalassemia. There was a significant

  12. Neuro-ophthalmology of invasive fungal sinusitis: 14 consecutive patients and a review of the literature.

    PubMed

    Thurtell, Matthew J; Chiu, Alison L S; Goold, Lucy A; Akdal, Gulden; Crompton, John L; Ahmed, Rebekah; Madge, Simon N; Selva, Dinesh; Francis, Ian; Ghabrial, Raf; Ananda, Arj; Gibson, John; Chan, Raymond; Thompson, Elizabeth O; Rodriguez, Michael; McCluskey, Peter J; Halmagyi, G Michael

    2013-08-01

    Invasive fungal sinusitis is a rare condition that usually occurs in immunocompromised patients and often presents as an orbital apex syndrome. It is frequently misdiagnosed on presentation and is almost always lethal without early treatment. Retrospective case series of 14 consecutive patients with biopsy-proven invasive fungal sinusitis from four tertiary hospitals. Fourteen patients (10 men and 4 women; age range 46-82 years). Retrospective chart review of all patients presenting with invasive fungal sinusitis between 1994 and 2010 at each hospital, with a close analysis of the tempo of the disease to identify any potential window of opportunity for treatment. Demographic data, background medical history (including predisposing factors), symptoms, signs, radiological findings, histopathological findings, treatment approach and subsequent clinical course were recorded and analysed. Only one patient was correctly diagnosed at presentation. Only two patients were not diabetic or immunocompromised. The tempo was acute in two patients, subacute in nine patients and chronic in three patients. In the subacute and chronic cases, there was about 1 week of opportunity for treatment, from the time there was a complete orbital apex syndrome, and still a chance for saving the patient, to the time there was central nervous system invasion, which was invariably fatal. Only two patients survived - both had orbital exenteration, as well as antifungal drug treatment. Invasive fungal sinusitis can, rarely, occur in healthy individuals and should be suspected as a possible cause of a progressive orbital apex syndrome. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

  13. [Physical therapy for idiopathic scoliosis].

    PubMed

    Steffan, K

    2015-11-01

    The objective is the description and summary of the current state of idiopathic scoliosis treatment with physical therapy based on new scientific knowledge and concluded from more than 15 years of experience as a leading physician in two well-known clinics specializing in the conservative treatment of scoliosis. Based on current scientific publications on physical therapy in scoliosis treatment and resulting from the considerable personal experience gained working with conservative treatment and consulting scoliosis patients (as inpatients and outpatients), the current methods of physical therapy have been compared and evaluated. Physical therapy according to Schroth and Vojta therapy are at present the most common and effective methods in the physical treatment of idiopathic scoliosis. These methods can be applied during inpatient or outpatient treatment or intensified in the practice of specialized therapists. As there are only a few scientific studies on this subject, the author's findings are based mainly on his own experiences of the conservative treatment of idiopathic scoliosis. Athough these experiences are the results of over 15 years of working in the field of therapy, and the Schroth method in combination with corrective bracing presents highly promising results, it would nevertheless be desirable to conduct detailed scientific studies to verify the effectiveness of conservative treatment.

  14. Anterior Petrosectomy: Consecutive Series of 46 Patients with Attention to Approach-Related Complications

    PubMed Central

    Gompel, Jamie J. Van; Alikhani, Puya; Youssef, A. Samy; Loveren, Harry R. van; Boyev, K. Paul; Agazzi, Sivero

    2015-01-01

    Objective Anterior petrosectomy(AP) was popularized in the 1980s and 1990s as micro-neurosurgery proliferated. Original reports concentrated on the anatomy of the approach and small case series. Recently, with the advent of additional endonasal approaches to the petrous apex, the morbidity of AP remains unclear. This report details approach-related morbidity around and under the temporal lobe. Methods A total of 46 consecutive patients identified from our surgical database were reviewed retrospectively. Results Of the 46 patients, 61% were women. Median age of the patients was 50 years (mean: 48 ± 2 years). Median follow-up of this cohort was 66 months. Most procedures dealt with intradural pathology (n = 40 [87%]). Approach-related morbidity consisted of only two patients (4%) with new postoperative seizures. There were only two significant postoperative hemorrhages (4%). Cerebrospinal fluid leakage occurred in two patients (4%) requiring reoperation. Conclusion Approach-related complications such as seizures and hematoma were infrequent in this series, < 4%. This report describes a contemporary group of patients treated with open AP and should serve as a comparison for approach-related morbidity of endoscopic approaches. Given the pathologies treated with this approach, the morbidity appears acceptable. PMID:26401480

  15. Anterior Petrosectomy: Consecutive Series of 46 Patients with Attention to Approach-Related Complications.

    PubMed

    Van Gompel, Jamie J; Alikhani, Puya; Youssef, A Samy; Loveren, Harry R van; Boyev, K Paul; Agazzi, Sivero

    2015-09-01

    Objective Anterior petrosectomy(AP) was popularized in the 1980s and 1990s as micro-neurosurgery proliferated. Original reports concentrated on the anatomy of the approach and small case series. Recently, with the advent of additional endonasal approaches to the petrous apex, the morbidity of AP remains unclear. This report details approach-related morbidity around and under the temporal lobe. Methods A total of 46 consecutive patients identified from our surgical database were reviewed retrospectively. Results Of the 46 patients, 61% were women. Median age of the patients was 50 years (mean: 48 ± 2 years). Median follow-up of this cohort was 66 months. Most procedures dealt with intradural pathology (n = 40 [87%]). Approach-related morbidity consisted of only two patients (4%) with new postoperative seizures. There were only two significant postoperative hemorrhages (4%). Cerebrospinal fluid leakage occurred in two patients (4%) requiring reoperation. Conclusion Approach-related complications such as seizures and hematoma were infrequent in this series, < 4%. This report describes a contemporary group of patients treated with open AP and should serve as a comparison for approach-related morbidity of endoscopic approaches. Given the pathologies treated with this approach, the morbidity appears acceptable.

  16. A comparison of the innervation characteristics of the lateral spinal ligaments between normal subjects and patients with adolescent idiopathic scoliosis.

    PubMed

    Jiang, H; Greidanus, N; Moreau, M; Mahood, J; Raso, V J; Russell, G; Bagnall, K

    1997-01-01

    Evidence is rapidly accumulating to suggest that general proprioceptive dysfunction might be a major contributing factor in the development of adolescent idiopathic scoliosis (AIS). The innervation of appropriate ligaments which has been shown to be involved in proprioceptive feedback mechanisms, has also been suggested to play a part in this sensory dysfunction. Accordingly, this study compared the innervation characteristics of lateral spinal ligaments from patients with AIS to similar measurements from control subjects. Using an antibody to neurofilament protein, Ruffini corpuscles, small and large nerve bundles, and free nerve endings were identified and their numbers and distribution patterns compared. In the control group, the innervation was found to be symmetrical between left and right sides but was more concentrated in the ventral portion of each ligament. No apparent morphological defect of the innervation was found in the lateral spinal ligaments of the scoliosis patients but the innervation densities of Ruffini corpuscles, single nerve fibres and total neural elements were significantly lower (p<0.01) than those found in normal subjects. These results suggest a possible mechanism for the production of AIS and warrant further study.

  17. Corrective Surgery for Congenital Scoliosis Associated with Split Cord Malformation: It May Be Safe to Leave Diastematomyelia Untreated in Patients with Intact or Stable Neurological Status.

    PubMed

    Shen, Jianxiong; Zhang, Jianguo; Feng, Fan; Wang, Yipeng; Qiu, Guixing; Li, Zheng

    2016-06-01

    The treatment of congenital scoliosis associated with split cord malformation (SCM) raises the issue of how to best manage such patients to avoid neurological deficit while achieving a satisfactory correction. This prospective clinical study was performed at our center from March 2000 through June 2013. We enrolled a total of 214 patients (61 male and 153 female) with congenital scoliosis associated with SCM who were undergoing spinal correction surgery. The mean age at surgery was 14.1 years. The inclusion criteria were congenital scoliosis with confirmed SCM; status as neurologically intact or stable over the preceding 2 years; and no neurological deterioration as evidenced on traction, side-bending, or fulcrum-bending radiographs. Patients with unstable neurological status or for whom vertebral column resection surgery was planned were excluded. All patients underwent scoliosis surgery without prophylactic detethering. On the basis of the Pang classification, 73 patients were in the type-I SCM group, and 141 were in the type-II SCM group. The groups did not differ significantly with respect to preoperative characteristics, operative time, blood loss, or number of levels fused. The mean follow-up was 37 months (range, 24 to 108 months). The rate of scoliosis correction was lower in the type-I group than in the type-II group (p < 0.05). In the type-I group, the correction rate was 48.9% at 1 week postoperatively and 42.2% at the last follow-up. In the type-II group, the correction rate was 54.7% at 1 week postoperatively and 47.9% at the last follow-up. Eleven (5.1%) of the patients experienced transient neurological complications, with no significant difference between the groups (p = 0.415). No patient experienced permanent neurological deficit during surgery or follow-up. Patients with congenital scoliosis associated with SCM, regardless of type, can safely and effectively undergo spinal deformity correction and achieve spinal balance without neurological

  18. Robot-assisted low anterior resection in fifty-three consecutive patients: an Indian experience.

    PubMed

    Kenawadekar, R D; Dhange, R Z; Pandit, A; Bandawar, M S; Joshi, S; Agarwal, G; Jagtap, A P; Puntambekar, S

    2013-12-01

    From December 2005 to December 2009, we performed 150 laparoscopic colorectal procedures. Based on this experience, we started offering robot-assisted colorectal surgery from December 2009. This study is a prospective evaluation of consecutive patients in order to study the technical feasibility and oncological outcome of robot-assisted low anterior resection. This investigation was conducted at a single minimal access surgery institute. Between December 2009 and December 2011, 53 consecutive patients with rectal adenocarcinoma underwent a robot-assisted low anterior resection (LAR) or ultralow anterior resection (ULAR) with total mesorectal excision (TME), using the standard da Vinci 'S' model. Patient demographics, mean operative time, mean postoperative hospital stay, blood loss, days to first flatus, resumption of oral feeds, urinary incontinence, and sexual dysfunction were studied. Surgical and pathological outcomes such as quality of TME, free circumferential margins, and number of lymph nodes dissected were also evaluated. Robot docking and undocking times were noted. Of the 53 patients, 41 were men and 12 were women. Their mean age was 66.7 years (range 37-90 years). The ASA grades were distributed as follows: ASA I 15 (28.3 %), ASA II 25 (47.16 %), ASA III 12 (22.64 %), ASA IV 1 (1.88 %). The mean operative time was 180 min (150-230 min) and the mean blood loss was 101.6 ml (50-300 ml). The robot docking time was 10 min (15-25 min) and the undocking time was 5 min (3-10 min). The mean hospital stay was 8 days (7-15 days). None of the patients was converted to either laparoscopic or open procedure. The longitudinal and circumferential margins were negative in all patients. Histopathological reports of 45 patients showed complete TME while 8 patients showed nearly complete TME. No repositioning of the robot was needed for splenic flexure mobilization, thus decreasing the operative time. Along with TME, even the splenic flexure mobilization

  19. Intramedullary gangliogliomas: clinical features, surgical outcomes, and neuropathic scoliosis.

    PubMed

    Yang, Chenlong; Li, Guang; Fang, Jingyi; Wu, Liang; Yang, Tao; Deng, Xiaofeng; Xu, Yulun

    2014-01-01

    Intramedullary spinal cord gangliogliomas are rare tumors composed of glial components and ganglion cells. These gangliogliomas are generally considered as slow-growing tumors, corresponding histologically to WHO grade I or II. There are few reports of large case series of intramedullary spinal cord gangliogliomas from a single center. We retrospectively reviewed a consecutive series of 18 patients with pathologically diagnosed ganglioglioma. Clinical manifestations, radiological features, treatment and follow-up data, and concomitant scoliosis were investigated. The mean age at diagnosis was 27.5 years, with a slight female predominance. The primary clinical symptoms were sensorimotor deficits. Magnetic resonance (MR) imaging manifestations varied considerably. Some associated, but not necessary, features were found, such as young age at onset, large tumor dimension, and bony changes. Scoliosis was observed in seven patients. Remnant tumor progression was observed in five patients during the follow-up period, and no deaths occurred. The last neurological evaluation showed functional improvement from preoperative status in five patients. Differential diagnosis of ganglioglioma based on MR images alone is challenging, but the combination of some characteristic features can be helpful. An accurate diagnosis of ganglioglioma depends on pathological criteria. Despite the benign course of ganglioglioma, considerable growth may affect its resectability and prognosis. The extent of resection should be meticulously planned, and the potential risk of recurrence and neurological deterioration should be evaluated. The concomitant scoliosis is noteworthy.

  20. Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients.

    PubMed

    Rohrich, Rod J; Leedy, Jason E; Swamy, Ravi; Brown, Spencer A; Coleman, Jayne

    2006-02-01

    In 1998, the senior author presented the intraoperative fluid ratio, defined as the volume of super-wet solution and intraoperative intravenous fluid divided by the aspiration volume, to guide resuscitation fluid volumes in super-wet liposuction. The senior author demonstrated that intraoperative fluid ratios of 2.1 for small-volume and 1.4 for large-volume liposuction were safe and did not cause volume overload sequelae. A high urine output was common and reflected a mild overresuscitation, which could have adverse consequences in patients with undiagnosed cardiopulmonary disease. The purpose of this study was to compare overresuscitation sequelae in a cohort of consecutive super-wet liposuction patients using a new fluid management formula in which replacement fluid was given after 5000 cc of lipoaspirate instead of 4000 cc, as initially described. The charts of 89 consecutive patients undergoing super-wet liposuction were retrospectively reviewed. The intraoperative fluid ratio was 1.8 for the small-volume reductions (< 5000 cc, n = 68) and 1.2 (> 5001 cc, n = 21) for the large-volume reductions. There were no episodes of pulmonary edema, congestive heart failure exacerbation, or other major complications. The average urine output in the operating room, the recovery room, and while on the floor was 1.5, 1.6, and 2.9 cc/kg/hour for the small-volume group and 1.7, 1.8, and 2.5 cc/kg/hour for the large-volume group. The super-wet subcutaneous infiltration liposuction technique for both small- and large-volume reductions is safe and can be performed without adverse cardiopulmonary sequelae. Given the high urine outputs, the intraoperative fluid ratio can be further improved by possibly eliminating the replacement fluid altogether.

  1. Preoperative particle and glue embolization of meningiomas: indications, results, and lessons learned from 117 consecutive patients.

    PubMed

    Borg, Anouk; Ekanayake, Jinendra; Mair, Richard; Smedley, Thomas; Brew, Stefan; Kitchen, Neil; Samandouras, George; Robertson, Fergus

    2013-12-01

    Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique. To evaluate the safety of presurgical embolization of meningiomas and its impact on subsequent transfusion requirement with respect to the extent of embolization and technique used. One hundred seventeen consecutive patients between 2001 and 2010 were referred for embolization of presumed intracranial meningioma before surgical resection. Glue and/or particles were used to devascularize the tumor in 107 patients, all of whom went on to operative resection. The extent and nature of embolization-related complications, degree of angiographic devascularization, and the intraoperative blood transfusion requirements were analyzed. Mean blood transfusion requirement during surgery was 0.8 units per case (range, 1-14 units). Blood transfusion was significantly lower in patients whose meningiomas were completely, angiographically devascularized (P = .035). Four patients had complications as a direct result of the embolization procedure. These included intratumoral hemorrhage in 2, sixth cranial nerve palsy in 1, and scalp necrosis requiring reconstructive surgery in 1 patient. The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that preoperative meningioma embolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.

  2. Preoperative Particle and Glue Embolization of Meningiomas: Indications, Results and Lessons Learned from 117 Consecutive Patients.

    PubMed

    Borg, Anouk; Ekanayake, Jinendra; Mair, Richard; Smedley, Thomas; Brew, Stefan; Kitchen, Neil; Samandouras, George; Robertson, Fergus

    2013-02-25

    BACKGROUND:: Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique. OBJECTIVE:: To evaluate the safety of presurgicalembolization of meningiomas and its impact on subsequent transfusion requirement, with respect to the extent of embolization and technique used. METHODS:: 117 consecutive patients between 2001 and 2010 were referred for embolization of presumed intracranial meningioma prior to surgical resection. Glue and/or particles were used to devascularize the tumor in 107 patients, all of whom went on to operative resection. The extent and nature of embolization-related complications, degree of angiographic devascularization, and the intraoperative blood transfusion requirements were analyzed. RESULTS:: Mean blood transfusion requirement during surgery was 0.8 units per case (range 1-14 units). Blood transfusion was significantly lower in patients whose meningiomas were completely, angiographicallydevascularized (P= .035). Four patients had complications as a direct result of the embolization procedure. These included intratumoral haemorrhage in two, sixth cranial nerve palsy in one, and scalp necrosis requiring reconstructive surgery in a further patient. CONCLUSION:: The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that pre-operative meningiomaembolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.

  3. Isolated pancreatic injuries: An analysis of 49 consecutive patients treated at a Level 1 Trauma Centre.

    PubMed

    Krige, J E J; Kotze, U K; Nicol, A J; Navsaria, P H

    2015-12-01

    This study interrogated a large prospectively documented institutional database to determine morbidity and mortality after an isolated pancreatic injury (IPI). Complications were graded according to the Clavien-Dindo classification and the International Study Group of Pancreatic Surgery (ISGPS) definitions. The degree of the pancreatic duct injury was graded using a modified Takishima duct injury classification. Primary endpoints were general and pancreas-specific morbidity and mortality. Four hundred and forty-eight consecutive patients were treated between 1990 and 2014 for pancreatic injuries of whom 49 (median age: 30, range: 13-68 years, 41 men, blunt injuries: n=43) had an IPI. Thirty-four (70%) patients underwent urgent surgery, 20 of whom had a distal pancreatectomy and 14 had external drainage of the pancreatic injury. Fifteen (30%) patients presented with a non-resolving pancreatic pseudocyst or fistula; five had grade 4A or 4B ductal injuries and underwent surgery, 10 with 3A and 3B ductal injuries were successfully managed endoscopically. Fifty-five percent had postoperative morbidity. Two patients (4%) died of non-pancreatic-related causes. While overall mortality is low after an IPI, morbidity is high. Two thirds of patients required operative intervention and one third were treated endoscopically. The degree of pancreatic ductal injury determined whether endoscopic intervention was effective. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  4. [The radiofrequency ablation of accessory pathways in 100 consecutive patients with supraventricular tachycardias].

    PubMed

    Colín, L; Kershenovich, S; Iturralde, P; Dan, L; Martínez Ríos, M A; Casanova, M; González Hermosillo, J A

    1993-01-01

    The purpose of this study is to describe the results and the complications of radiofrequency catheter ablation, of accessory pathways in 100 consecutive patients. We had one patient with two pathways. Of the 101 accessory pathways, 56 were overt and 45 concealed. Only 19 patients have had a previous electrophysiology study, in the others, the study and the ablation were performed simultaneously. The location of the accessory pathways were as follows: 61 pathways in the free wall of the left ventricle, 4 in the free wall of the right ventricle, 25 in the left posteroseptal region, 9 in the right posteroseptal region and 2 in the right anteroseptal area. The time required for the diagnostic component of the electrophysiology study, the ablation procedure and the fluoroscopic time was recorded for each patient. Ninety-one of 101 accessory AV connections were successfully ablated (90%). Our success rate for the initial attempt was 87%. We had the opportunity to do a second attempt in only 4 out of 14 patients. The mean time of the procedure, including the electrophysiology test and the ablation was 95.6 %/-55.3 minutes. We have had a recurrence of 9% and 4% of non fatal complications. Radiofrequency catheter ablation can be performed safely and with a high success rate.

  5. Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients

    PubMed Central

    Koh, Frederick Hong-Xiang; Shi, Wang

    2017-01-01

    The biliary duct is an extremely rare site for colon cancer metastasis. It often leads to a diagnostic dilemma, since primary cholangiocarcinoma (potentially treatable with surgery) has a similar presentation. This paper highlights our experience with 5 consecutive patients who had colon malignancy with biliary metastasis, and prognosis of their disease. Five patients, with a history of primary colon cancer since 2010, were identified to have biliary metastasis. Of these, 4 (80.0%) patients were male. The median time to diagnosis of biliary metastasis from diagnosis of colon cancer was 59.2 months (0-70.1 months), and all exhibited symptoms of biliary obstruction or its associated complications. Evaluation of the tumour samples revealed all specimens to be negative for CK7 but positive for CK20, suggestive of a colorectal primary. The median survival of the 5 patients was 23.5 months (1.8-44.5 months) from the diagnosis of biliary metastasis. However, none of their death was related to the direct complication of biliary obstruction. Biliary metastasis is a rare entity for metastatic colon malignancy. Diagnosis may be difficult radiologically, and immunohistochemical staining may help in identification. The overall survival for these patients is dismal. PMID:28317047

  6. Posterior Correction Without Rib-head Resection for Patients With Neurofibromatosis Type 1, Dystrophic Scoliosis, and Rib-head Protrusion Into the Spinal Canal.

    PubMed

    Cai, Siyi; Zhang, Jianguo; Shen, Jianxiong; Zhao, Hong; Weng, Xisheng; Qiu, Guixing

    2017-02-01

    A retrospective study. The objective of this study is to report the result of patients with neurofibromatosis type 1(NF-1), dystrophic scoliosis, and rib-head protrusion into the spinal canal who received posterior scoliosis correction surgery without rib-head resection. A total of 124 patients with NF-1 and dystrophic scoliosis were treated at our institution during the study period. Eight patients with a median age of 12 years had rib-head protrusion into the spinal canal and received surgery and were included in the analysis. All 8 patients (6 male, 2 female) were treated from 2003 to 2013 and received posterior correction with a pedicle screw-rod 3-dimensional correction system or screw-hook hybrid system. Scoliosis correction rate and percentage of spinal canal occupied by the rib head were analyzed. The median patient age, number of segments fused, and follow-up duration were 12 years, 10.5, and 22.5 months, respectively. There were no surgery-related complications, and symptoms in all patients improved after surgery. The median postoperative and 1-year follow-up sagittal kyphotic angles were significantly smaller as compared with the preoperative value (28.5 and 31 vs. 62.5 degrees, P=0.012). The median postoperative coronal Cobb angle of the main thoracic curve was significantly smaller compared with the preoperative value (29 vs. 64.5 degrees, P=0.012). The median percentage of the spinal canal occupied by the intraspinal rib was significantly lower at 1-year follow-up compared with the preoperative value (23.1% vs. 28.6%, P=0.018). Posterior correction without rib-head excision can provide good outcomes for patients with NF-1 and dystrophic scoliosis and rib-head protrusion into the spinal canal.

  7. Changes in the unfused lumbar spine in patients with idiopathic scoliosis. A 5- to 9-year assessment after cotrel-dubousset instrumentation.

    PubMed

    Takahashi, S; Delécrin, J; Passuti, N

    1997-03-01

    Postoperative changes in the lumbar spine were studied retrospectively in patients with adolescent idiopathic scoliosis who had been treated with Cotrel-Dubousset instrumentation. To examine middle-term changes in the unfused lumbar segments below an instrumented scoliosis fusion. Scoliosis fusion by the Harrington method is known to be associated with a flat back in the fused area and subsequent degenerative changes in the segments below the fusion. No data have yet been published concerning a segmental instrumentation system. Thirty patients with idiopathic scoliosis, between the ages of 14 and 22 years at the time of surgery, were observed for 5-9 years after surgery. Activity, pain, complications, and 21 radiographic parameters were assessed. The prevalence of low back pain increased from 3% before surgery to 20% at the final follow-up visit, although in none of the patients was the pain so severe that specific treatment was required. Radiographically, uninstrumented lumbar segments generally were realigned successfully in the frontal plane. Analyses in the sagittal plane revealed tendencies to a gradual increase in lumbar lordosis, anterior-upward tilting of the lowest instrumented vertebra, and posterior shift of the sagittal spinal balance. During the follow-up period, seven patients (23%) developed degenerative changes, including mild junctional kyphosis, retrolisthesis, narrowing of disc spaces, or osteophytes. Whereas the overall clinical and radiographic results of surgery were satisfactory, the unfused lumbar segments required careful surveillance, especially in the sagittal plane.

  8. Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease

    PubMed Central

    Zrinzo, L.; Martinez-Torres, I.; Frost, E.; Pinto, S.; Foltynie, T.; Holl, E.; Petersen, E.; Roughton, M.; Hariz, M.I.; Limousin, P.

    2011-01-01

    Objective: Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short- and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change. Methods: Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on- and off-medication with on- and off-stimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year. Results: Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2% ± 20.15% off-medication and 16.9% ± 21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6% ± 5.5% and 4.5% ± 8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year. Conclusion: The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients. Classification of evidence: This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1

  9. Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease.

    PubMed

    Tripoliti, E; Zrinzo, L; Martinez-Torres, I; Frost, E; Pinto, S; Foltynie, T; Holl, E; Petersen, E; Roughton, M; Hariz, M I; Limousin, P

    2011-01-04

    Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short- and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change. Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on- and off-medication with on- and off-stimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year. Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2%±20.15% off-medication and 16.9%±21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6%±5.5% and 4.5%±8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year. The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients. This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1 month, 6 months, and 1 year compared to baseline and to control subjects

  10. SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis

    PubMed Central

    2014-01-01

    This 2012 Consensus paper reviews the literature on side effects of x-ray exposure in the pediatric population as it relates to scoliosis evaluation and treatment. Alternative methods of spinal assessment and imaging are reviewed, and strategies for reducing the number of radiographs are developed. Using the Delphi technique, SOSORT members developed consensus statements that describe how often radiographs should be taken in each of the pediatric and adolescent sub-populations. PMID:24782912

  11. Nonmalignant Pleural Effusions: A Prospective Study of 356 Consecutive Unselected Patients.

    PubMed

    Walker, Steven P; Morley, Anna J; Stadon, Louise; De Fonseka, Duneesha; Arnold, David T; Medford, Andrew R L; Maskell, Nick A

    2017-05-01

    Pleural effusion secondary to a nonmalignant cause can represent significant morbidity and mortality. Nonmalignant pleural effusion (NMPE) is common, with congestive heart failure representing the leading cause. Despite this, there are limited data on mortality risk and associated prognostic factors. We recruited 782 consecutive patients presenting to a pleural service between March 2008 and March 2015 with an undiagnosed pleural effusion. Further analysis was conducted in 356 patients with NMPE. Pleural biochemical analysis, cytologic analysis, thoracic ultrasonography, and chest radiography were performed. Echocardiography, CT imaging, radiologically guided biopsy, and medical thoracoscopy were undertaken as clinically indicated. Patients were followed for a minimum duration of 12 months, with the final diagnosis decided through independent review by two respiratory consultants. Of the 782 patients, 356 were diagnosed with NMPE (46%). These patients had a mean age of 68 years (SD, 17 years) with 69% of them being men. Patients with cardiac, renal, and hepatic failure had 1-year mortality rates of 50%, 46%, and 25%, respectively. Bilateral effusions (hazard ratio [HR], 3.55; 95% CI, 2.22-5.68) and transudative effusions (HR, 2.78; 95% CI, 1.81-4.28) were associated with a worse prognosis in patients with NMPE, with a 57% and 43% 1-year mortality rate, respectively. This is the largest prospectively collected series in patients with NMPE, demonstrating that cases secondary to organ dysfunction have extremely high 1-year mortality. In addition, the presence of bilateral and transudative effusions is an indicator of increased mortality. Clinicians should be aware of these poor prognostic features and guide management accordingly. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  12. Laparoscopic Pancreatoduodenectomy in 50 Consecutive Patients with No Mortality: A Single-Center Experience.

    PubMed

    Machado, Marcel Autran C; Surjan, Rodrigo C; Basseres, Tiago; Silva, Izabella B; Makdissi, Fábio F

    2016-08-01

    Laparoscopic pancreatic surgery has gradually expanded to include pancreatoduodenectomy (PD). This study presents data regarding the efficacy of laparoscopic PD in a single center. This was a single-cohort, prospective observational study. From March 2012 to September 2015, 50 consecutive patients underwent laparoscopic PD using a five-trocar technique. Reconstruction of the digestive tract was performed with double jejunal loop technique whenever feasible. Patients with radiological signs of portal vein invasion were operated by open approach. Twenty-seven women and 23 men with a median age of 63 years (range 23-76) underwent laparoscopic PD. Five patients underwent total pancreatectomy. All, but 1 patient (previous bariatric operation), underwent pylorus-preserving resection. Reconstruction was performed with double jejunal loop in all cases except in 5 cases of total pancreatectomy. Conversion was required in 3 patients (6%) as a result of difficult dissection (two cases) and unsuspected portal vein invasion (1 patient). Median operative time was 420 minutes (range 360-660), and the 90-day mortality was nil. Pancreatic fistula occurred in 13 patients (26%). There was one grade C (reoperated), one grade B (percutaneous drainage), and all remaining were grade A (conservative treatment). Other complications included port site bleeding (n = 1), biliary fistula (n = 2), and delayed gastric emptying (n = 2). Mean hospital stay was 8.4 days (range 5-31). Laparoscopic PD is feasible and safe, but is technically demanding and may be reserved to highly skilled laparoscopic surgeons with proper training in high-volume centers. Isolated pancreatic anastomosis may be useful to decrease the severity of postoperative pancreatic fistulas. Therefore, it could be a good option in patients with a high risk for developing postoperative pancreatic, as well as by less-experienced surgeons.

  13. Adolescent Idiopathic Scoliosis

    PubMed Central

    Rinsky, Lawrence A.; Gamble, James G.

    1988-01-01

    Adolescent idiopathic scoliosis is the single most common form of spinal deformity seen in orthopedic practice. Our knowledge about the epidemiology, etiology, natural history, and treatment has recently increased dramatically. The incidence of small curves is rather high (2% of the population), whereas severe curves are much less common (<0.1%), but we cannot always predict which curve will progress. Abnormalities of the neuromuscular system and of calcium metabolism, and certain growth, genetic, and mechanical factors may all play roles in the pathogenesis of the disorder. The physiologic secondary effects of severe scoliosis relate to restrictive lung disease, but most patients do not have a deformity great enough to affect their cardiorespiratory function. The psychological and social effects of scoliosis are significant for patients but difficult to quantitate. For most patients with moderate scoliosis—that is, more than 25 to 30 degrees—treatment with an underarm brace or electrical stimulation is adequate to “control” progression of the curve. Surgical fusion allows actual correction of the curve but is indicated in only a small percentage of patients—usually those with more than 50 degrees of deformity. Images PMID:3279708

  14. [Single-port laparoscopic stoma creation for fecal diversion - experience of ten consecutive patients].

    PubMed

    Yagi, Ryoma; Kameyama, Hitoshi; Nakano, Mae; Sato, You; Kido, Tomoki; Nakano, Masato; Shimada, Yoshifumi; Sakata, Jun; Kobayashi, Takashi; Minagawa, Masahiro; Kosugi, Shinichi; Koyama, Yu; Wakai, Toshifumi

    2014-11-01

    In the present study, we aimed to describe the surgical results of single-port laparoscopic stoma creation in our institution. We examined the safety of the surgical procedure and short-term results in 10 consecutive patients who underwent single-port laparoscopic stoma creation at our hospital between April 2011 and July 2013. The median age of the patients was 60.5 (range, 31-75) years. Five patients were men, and 5 were women. There were 5 cases of colorectal cancer, 2 each of extramammary Paget's disease and uterine cancer, and one of perineal neurofibroma. Eight surgeries were performed for bowel obstruction or stenosis, and two surgeries were performed for other reasons. The median operative time was 59.5 (range, 40-91) min, blood loss volume was 0 (range, 0-10) mL, postoperative duration before commencement of oral intake was 2.5 (range, 1-4) days, and duration of postoperative hospital stay was 11(range, 5-19) days. No short-term complications were noted after the surgery. Single-port laparoscopic stoma creation appears to be feasible in terms of safety and short-term surgical results, and may improve the quality of life of patients requiring fecal diversion.

  15. Effects of intracoronary injection of ergonovine on angiographic normal coronary arteries: study of 108 consecutive patients.

    PubMed

    Fournier, J A; Cortacero, J A; Turá, A; Hernández-Aparicio, C; Granado, C; Vallejo, J

    1989-10-01

    To assess the local and systemic intracoronary (IC) ergonovine maleate (EM), single or repeated 25 micrograms bolus injections were administered to 108 consecutive patients with chest pain and normal coronary arteriograms. Coronary artery spasm (CAS) was induced in 17 (15.7%) patients. None of these patients developed ST-segment depression, and ST-segment elevation appeared in only 6 (35.3%). In 59 of the 91 patients without CAS, both the IC and the intravenous (IV) EM arteriographic and hemodynamic effects were compared. The mean diameter of the vessels was reduced by 15% (p less than 0.001) after two single 25 micrograms ICEM injections. Only insignificant changes were induced in the heart rate (baseline 80 +/- 15; after ICEM 79 +/- 15 beats/min; p = NS) and systolic aortic pressure (baseline 147 +/- 27; after ICEM 149 +/- 28 mmHG; p = NS). Following 350 micrograms of cumulative IVEM, the mean coronary diameter decreased by 20% (p less than 0.01 vs. ICEM dose) and the heart rate diminished slightly (76 +/- 12 beats/min, p less than 0.01). However, the systolic aortic pressures did increase by 16% (171 +/- 28 mmHg; p less than 0.001). No major complications were observed. Thus, to induce CAS the IC delivery route appears to be safe, allows for more accurate titration, and adverse systemic effects, such as hypertension, are avoided.

  16. Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years.

    PubMed

    Leotte, Jaqueline; Trombetta, Hygor; Faggion, Heloisa Z; Almeida, Bernardo M; Nogueira, Meri B; Vidal, Luine R; Raboni, Sonia M

    To report epidemiological features, clinical characteristics, and outcomes of human rhinovirus (HRV) infections in comparison with other community acquired respiratory virus (CRV) infections in patients hospitalized for two consecutive years. This was a cross-sectional study. Clinical, epidemiological, and laboratory data of patients hospitalized with acute respiratory syndrome in a tertiary care hospital from 2012 to 2013 were reviewed. HRV was the most common CRV observed (36%, 162/444) and was present in the majority of viral co-detections (69%, 88/128), mainly in association with human enterovirus (45%). Most HRV-infected patients were younger than 2 years (57%). Overall, patients infected with HRV had a lower frequency of severe acute respiratory infection than those infected with other CRVs (60% and 84%, respectively, p=0.006), but had more comorbidities (40% and 27%, respectively; p=0.043). However, in the adjusted analysis this association was not significant. The mortality rate within the HRV group was 3%. Detection of HRV was more prevalent during autumn and winter, with a moderately negative correlation between viral infection frequency and temperature (r=-0.636, p<0.001) but no correlation with rainfall (r=-0.036, p=0.866). HRV is usually detected in hospitalized children with respiratory infections and is often present in viral co-detections. Comorbidities are closely associated with HRV infections. These infections show seasonal variation, with predominance during colder seasons. Copyright © 2016. Published by Elsevier Editora Ltda.

  17. Male-female differences in Scoliosis Research Society-30 scores in adolescent idiopathic scoliosis.

    PubMed

    Roberts, David W; Savage, Jason W; Schwartz, Daniel G; Carreon, Leah Y; Sucato, Daniel J; Sanders, James O; Richards, Benjamin Stephens; Lenke, Lawrence G; Emans, John B; Parent, Stefan; Sarwark, John F

    2011-01-01

    Longitudinal cohort study. To compare functional outcomes between male and female patients before and after surgery for adolescent idiopathic scoliosis (AIS). There is no clear consensus in the existing literature with respect to sex differences in functional outcomes in the surgical treatment of AIS. A prospective, consecutive, multicenter database of patients who underwent surgical correction for adolescent idiopathic scoliosis was analyzed retrospectively. All patients completed Scoliosis Research Society-30 (SRS-30) questionnaires before and 2 years after surgery. Patients with previous spine surgery were excluded. Data were collected for sex, age, Risser grade, previous bracing history, maximum preoperative Cobb angle, curve correction at 2 years, and SRS-30 domain scores. Paired sample t tests were used to compare preoperative and postoperative scores within each sex. Independent sample t tests were used to compare scores between sexes. A P value of <0.05 was considered statistically significant. Seven hundred forty-four patients (621 females and 123 males) were included. On average, males were 1 year older than females. There were no differences between sexes in Risser grade, bracing history, maximum curve magnitude, or correction after surgery. Both males and females had similar improvement in all SRS-30 domains after surgery. Self-image/appearance had the greatest relative improvement. Males had better self-image/appearance scores preoperatively, better pain scores at 2 years, and better mental health and total scores both preoperatively and at 2 years. Both males and females were similarly satisfied with surgery. Males treated with surgery for AIS report better preoperative self-image, less postoperative pain, and better mental health than females. These differences may be clinically significant. For both males and females, the most beneficial effect of surgery is improved self-image/appearance. Overall, the benefits of surgery for AIS are similar for

  18. Relation between self-image score of SRS-22 with deformity measures in female adolescent idiopathic scoliosis patients.

    PubMed

    Wang, L; Wang, Y P; Yu, B; Zhang, J G; Shen, J X; Qiu, G X; Li, Y

    2014-11-01

    Adolescent idiopathic scoliosis (AIS) is a pathology which affects the individual's functioning in the widely understood physical, psychic, and social aspects. More attention should be paid to patients' perception of self-image when evaluating the spine deformity. The present retrospective study evaluated the associations between the deformity measures and self-image score as determined by the SRS-22 questionnaire in Chinese female AIS patients. The self-image score correlates significantly with deformity measures. The location of main curve apex and the number of curve could affect the self-image score. We retrospectively reviewed the records of 202 female patients, collected data on patient's age, body mass index, radiographic and physical measures and self-image score of SRS-22 questionnaire. According to the location of main curve apex and the number of curve, the patients were divided to different subgroups. Correlations between deformity measures and self-image score of different groups were evaluated by the Spearman correlation test. The self-image score correlated negatively with the main Cobb angle, apical vertebral translation (AVT), and razor hump height. There is no significant difference of self-image score between thoracic curve (TC) and thoracolumbar curve (TL/LC) subgroups. And the self-image scores of one-curve, two-curve and three-curve subgroups are similar. For Chinese female AIS patients in our study, self-image was found to correlate negatively with the main Cobb angle, AVT and razor hump height. And the location of scoliosis apex and the number of curve are not influencing factors of self-image perception. Level IV, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Chiropractic Rehabilitation for Adolescent Idiopathic Scoliosis: End-of-Growth and Skeletal Maturity Results.

    PubMed

    Morningstar, Mark W; Dovorany, Brian; Stitzel, Clayton J; Siddiqui, Aatif

    2017-01-11

    The aim of this study was to evaluate the radiographic outcomes obtained in a sample of patients treated with a chiropractic scoliosis-specific exercise program for patients with adolescent idiopathic scoliosis. Patients were treated and subsequently followed through skeletal maturity, and their results were reported in accordance with the SOSORT Consensus Guidelines. A total of 60 patient charts were consecutively selected when they met inclusion criteria. Cobb angle measurements and Risser staging were collected on all images. Using SOSORT criteria, 51.7% of patients achieved curve correction and 38.3% achieved stabilization. In the curve correction group, average total correction was 12.75°. A small number of sampled patients' curves progressed, with a 13% failure rate based upon patients who dropped out before skeletal maturity combined with those who had progressed at skeletal maturity. Future studies are needed to corroborate these observations.

  20. Predictors of oliguric acute kidney injury in leptospirosis. A retrospective study on 196 consecutive patients.

    PubMed

    Daher, Elizabeth F; Silva, Geraldo B; Karbage, Nahme N N; Carvalho, Paulo C; Kataoka, Raquel S; Silva, Eveline C; Magalhães, Max M; Mota, Rosa M S; Araújo, Sônia M H A; Gutiérrez-Adrianzén, Oswaldo A; Libório, Alexandre B

    2009-01-01

    Acute kidney injury (AKI) occurs in 10 to 60% of patients with leptospirosis. The aim of this study is to investigate markers for oliguric AKI in leptospirosis. A retrospective study was performed with 196 consecutive patients with leptospirosis-associated AKI. These patients were categorized into either oliguric or non-oliguric according to their urine output. Clinical and laboratory characteristics were compared between the two groups. Among these patients, 64 (32.6%) were oliguric and 132 (67.4%) nonoliguric. Markers for oliguria were age higher than 40 years (OR = 1.02, p = 0.04), hyponatremia (OR = 0.94, p = 0.03), elevated serum creatinine (OR = 1.11, p = 0.04), low arterial pH (OR = 1.0002, p = 0.01), high levels of AST (OR = 1.005, p = 0.01), crackles (OR = 3.83, p < 0.001) and direct bilirubin (OR = 1.03, p = 0.03). Elevated activated prothrombin time (OR = 0.97, p = 0.03) was a factor associated with nonoliguric AKI. Independent markers for oliguria were crackles (OR = 5.17, p = 0.0016) and direct bilirubin levels (OR = 1.051, p = 0.04). Mortality was significantly higher in oliguric than nonoliguric (27 vs. 8%, p < 0.001). Renal function at discharge was similar in oliguric and nonoliguric patients. Age higher than 40 years, hyponatremia, elevated serum creatinine, low arterial pH, high levels of AST, crackles and direct bilirubin levels would be useful to early identify patients with oliguric AKI in leptospirosis. Copyright 2009 S. Karger AG, Basel.

  1. Oral habits in a group of consecutively treated orthodontic patients, using standardized video recordings for diagnosis.

    PubMed

    Torgersbråten, Nina; Linge, Leif; Vandevska-Radunovic, Vaska

    2012-12-01

    To investigate the prevalence and correlation of soft tissue dysfunctions documented by standardized video recordings in a group of orthodontic patients and to evaluate orthodontic treatment changes. The presence of an oral habit was evaluated from standardized pre- and post-treatment video recordings of 80 consecutive patients (30 boys and 50 girls, mean age 12.2 ± 1.7 years). Any digit-sucking habit was noted during a routine interview. Pre- and post-treatment cephalograms were traced to assess sagittal and vertical jaw and incisor relationships. Correlations and differences were tested for statistical significance using the t-test and Odds-ratio. 56.3% had one or more habits before treatment. The total prevalence fell during treatment. A clear correlation was found between digit sucking and atypical tongue activity. Pre-treatment cephalograms showed that patients with a habit had a larger overjet, smaller overbite, more proclined and protruded incisors, a greater ANB angle and a greater inter-maxillary angle (ML/NL) than those without a habit. Cephalometric differences between the groups after orthodontic treatment were much less pronounced. Those with an oral habit also showed a tendency for increased treatment time/number of visits. Standardized video recordings improved the reliability of the recordings of the oral soft tissue dysfunctions. Their overall reduction after the end of orthodontic treatment coincided with a normalization of the sagittal skeletal and dental variables.

  2. Facial asymmetry and condylar hyperplasia: considerations for diagnosis in 27 consecutives patients

    PubMed Central

    Olate, Sergio; Almeida, Andrés; Alister, Juan Pablo; Navarro, Pablo; Netto, Henrique Duque; de Moraes, Márcio

    2013-01-01

    Facial asymmetry associated with condylar hyperplasia (CH) has been become the object of study in recent years. The aim of this study is to demonstrate the importance of analyzing the presence of CH in cases of facial asymmetry. Twenty-seven consecutive patients were studied without distinction of age or gender; all the patients consulted for treatment of facial and/or mandibular asymmetry and voluntarily agreed to participate in the study. All the patients underwent facial cone beam tomography and bilateral TMJ as well as a detailed history where they indicated the progression of the disease; in cases of active evolution determined by clinical analysis and imaging, a SPECT analysis was performed to define the isotope uptake. 29.6% of the subjects with scintigram exhibited active CH with a more than 10% difference in uptake between the two condyles; 18.5% presented differences in uptake between 5% and 10%. Active CH was related to the age and gender of the subjects, being more prevalent in women than in men. The aggression level of the uptake was also related to the subject’s age. 55% of the subjects presented with some type of orthodontic treatment with no diagnosis of TMJ pathology in the initial consultation. It can be concluded that CH is associated with facial asymmetries and must be studied integrally before assessing treatment options. PMID:24260600

  3. Photoselective vaporization of the prostate: outcomes and adverse events of 220 consecutive patients

    NASA Astrophysics Data System (ADS)

    Robson, C.; Mueller, E. J.

    2010-02-01

    Purpose: To evaluate the short term outcomes of 220 consecutive patients who underwent the 532 nm KTP photoselective vaporization of the prostate (PVP) procedure and to evaluate and categorize the complications of the procedure. Materials and Methods: A total of 220 patients with symptomatic benign prostatic obstruction were treated with KTP photoselective vaporization of the prostate. Evaluation measures included the AUA Symptom Score (AUASS)/Quality of Life Score (QOL), peak urinary flow rate (Qmax), post void residual urine (PVR) and adverse events. Results: Symptoms were evaluated at 3 months and adverse events at 1 and 3 months. 181 patients returned for their 1 month visit and 152 returned for their 3 month visit. The American Urological Association Symptom Score (AUASS) decreased from 21.8 to 6.7. The Quality of Life Score (QOL) decreased from 3.8 to 0.7. The peak urinary flow rate (Qmax) increased from 10.7 cc/sec to 22.7 cc/sec. And the post void residual urine (PVR) decreased from 262 cc to 105 cc. Most common adverse events lasting more than 10 days were mild hematuria in 45%, dysuria in 32%, and urgency/frequency in31%. Conclusion: These results confirm that photoselective vaporization of the prostate (PVP) is a safe and effective therapy for benign prostatic obstruction. However, there is frequent, but mild, hematuria and irritative voiding symptoms during the early postoperative period.

  4. Distal Adding-on and Risk Factors in Severe and Rigid Scoliosis.

    PubMed

    Zang, Lei; Hai, Yong; Yuan, Shuo; Su, Qingjun; Yang, Jincai; Guan, Li; Kang, Nan; Meng, Xianglong; Liu, Yuzeng; Fan, Ning

    2017-02-01

    A retrospective study. The aim of this study was to identify associated risk factors of distal adding-on in severe and rigid scoliosis. Previous work has evaluated the challenges in the treatment of patients with severe and rigid scoliosis and the risks of complications. Furthermore, although several studies have investigated postoperative distal adding-on and attendant risk factors in Lenke type 1A scoliosis, very few have focused on distal adding-on in severe and rigid scoliosis. In this study, 48 consecutive patients with severe and rigid scoliosis underwent posterior spinal fusion surgery. The parameters of preoperative, immediately postoperative, and minimum 2-year follow-up radiographs were evaluated. The patients were classified as positive or negative for distal adding-on at follow-up, and risk factors were comparatively analyzed in the two groups. The average Cobb angle and flexibility of the main thoracic curve (MTC) were 107.4° ± 15.9° and 16.4% ± 10.2%, respectively, before surgery. Distal adding-on was observed in 12 patients (25.0%) at follow-up. Univariate analysis identified several factors significantly associated with distal adding-on. Furthermore, significant independent risk factors identified by stepwise logistic regression analysis included the correction rate of the MTC immediately after surgery (odds ratio: 1.107, 95% confidence interval: 1.024-1.197, P = 0.011) and the difference between the lower instrumented vertebra (LIV) and last touching vertebra (LTV) levels (odds ratio: 0.121, 95% confidence interval: 0.028-0.518, P = 0.004). In severe and rigid scoliosis, a high correction rate of the MTC immediately after surgery and the LIV level above the LTV were significantly associated with distal adding-on. 3.

  5. Quadriceps muscle strength in scoliosis.

    PubMed

    Swallow, E B; Barreiro, E; Gosker, H; Sathyapala, S A; Sanchez, F; Hopkinson, N S; Moxham, J; Schols, A; Gea, J; Polkey, M I

    2009-12-01

    Quadriceps muscle weakness is an important component of chronic obstructive pulmonary disease (COPD). We hypothesised that quadriceps weakness would also be a feature of restrictive lung disease due to scoliosis. We studied 10 patients with severe scoliosis (median (interquartile range (IQR)) forced expiratory volume in 1 s (FEV(1))() 35.3 (11)% predicted), 10 patients with severe COPD (FEV(1) 26.5 (9.0)% pred) and 10 healthy age-matched adults. We measured quadriceps strength, exercise capacity and analysed quadriceps muscle biopsies for myosin heavy-chain (MyHC) isoform expression and the presence of oxidative stress. Both groups exhibited quadriceps weakness with median (IQR) maximal voluntary contraction force being 46.0 (17.0) kg, 21.5 (21.0) kg and 31.5 (11.0) kg, respectively (p = 0.02 and 0.04, respectively, for each patient group against controls). Oxidative stress was significantly greater in the quadriceps of both restrictive and COPD patients. The scoliosis patients exhibited a decrease in the proportion of MyHC type I compared with controls; median (IQR) 35.3 (18.5)% compared with 47.7 (9.3)%, p = 0.028. The scoliosis patients also showed an increase in MyHC IIx (26.3 (15.5)% compared with 11.3 (13.0)%, p = 0.01. Quadriceps weakness is a feature of severe scoliosis; the similarities between patients with scoliosis and patients with COPD suggest a common aetiology to quadriceps weakness in both conditions.

  6. A comparison of anterior and posterior instrumentation for restoring and retaining sagittal balance in patients with idiopathic adolescent scoliosis.

    PubMed

    Tao, Fenghua; Wang, Zhiwei; Li, Ming; Pan, Feng; Shi, Zhicai; Zhang, Ye; Wu, Yungang; Xie, Yang

    2012-08-01

    Retrospective, comparative study. To compare the effects of anterior rod-screw instrumentation and posterior pedicle screw instrumentation on sagittal balance in patients with Lenke type 5 adolescent idiopathic scoliosis (AIS). Lenke type 5 AIS is treated by anterior or posterior spinal fusion surgery. Most studies comparing anterior and posterior fusion surgery have focused on assessing improvement in coronal balance. Studies comparing the effects of anterior and posterior surgery on sagittal balance are lacking. The records of 49 patients diagnosed with Lenke type 5 AIS were examined. A total of 21 patients underwent anterior surgery between 2000 and 2003, while 26 underwent posterior surgery between 2004 and 2006. Preoperative, postoperative, and follow-up thoracic kyphosis (T5-T12 and T2-T12), lumbar lordosis, thoracolumbar junction kyphosis, and spinal vertical axis measurements were made by examining radiographs. Quality of life was assessed using the Scoliosis Research Society-22 questionnaire. All patients were followed up for at least 2 years. There were no significant between group differences in coronal alignment, thoracic kyphosis, or T11-L2 alignment after surgery. Sagittal alignment improvement was significantly more pronounced in the anterior surgery group compared with the posterior surgery group. The fusion segment was also significantly shorter in the anterior surgery compared with the posterior surgery group. Quality of life scores were significantly higher in the anterior surgery group compared with the posterior surgery group. Anterior solid rod-screw instrumentation results in shorter fusion segments, and better sagittal alignment and quality of life than posterior pedicle screw instrumentation in patients with Lenke type 5 AIS.

  7. Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients.

    PubMed

    Johari, Joehaimey; Sharifudin, Mohd Ariff; Ab Rahman, Azriani; Omar, Ahmad Sabri; Abdullah, Ahmad Tajudin; Nor, Sobri; Lam, Weii Cheak; Yusof, Mohd Imran

    2016-01-01

    This retrospective review aimed to examine the relationship between preoperative pulmonary function and the Cobb angle, location of apical vertebrae and age in adolescent idiopathic scoliosis (AIS). To our knowledge, there have been no detailed analyses of preoperative pulmonary function in relation to these three factors in AIS. A total of 38 patients with thoracic or thoracolumbar scoliosis were included. Curvature of spinal deformity was measured using the Cobb method. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were used to evaluate preoperative pulmonary function. Statistical methods were used to analyse the relationship between preoperative pulmonary function and the factors that may contribute to poor pulmonary function. The mean age of the patients was 16.68 ± 6.04 years. An inverse relationship was found between the degree of the Cobb angle and FVC as well as FEV1; however, the relationships were not statistically significant (p = 0.057 and p = 0.072, respectively). There was also a trend towards a significant negative correlation between the thoracic curve and FVC (p = 0.014). Patients with larger thoracic curves had lower pulmonary function. A one-year increase in age significantly decreased FVC by 1.092 units (p = 0.044). No significant relationship between age and preoperative FEV1 was found. The median FVC was significantly higher in patients with affected apical vertebrae located at levels L1-L3 than at T6-T8 or T9-T12 (p = 0.006). Lung function impairment was seen in more severe spinal deformities, proximally-located curvature and older patients. Copyright © Singapore Medical Association.

  8. Understanding how axial loads on the spine influence segmental biomechanics for idiopathic scoliosis patients: A magnetic resonance imaging study.

    PubMed

    Little, J P; Pearcy, M J; Izatt, M T; Boom, K; Labrom, R D; Askin, G N; Adam, C J

    2016-02-01

    Segmental biomechanics of the scoliotic spine are important since the overall spinal deformity is comprised of the cumulative coronal and axial rotations of individual joints. This study investigates the coronal plane segmental biomechanics for adolescent idiopathic scoliosis patients in response to physiologically relevant axial compression. Individual spinal joint compliance in the coronal plane was measured for a series of 15 idiopathic scoliosis patients using axially loaded magnetic resonance imaging. Each patient was first imaged in the supine position with no axial load, and then again following application of an axial compressive load. Coronal plane disc wedge angles in the unloaded and loaded configurations were measured. Joint moments exerted by the axial compressive load were used to derive estimates of individual joint compliance. The mean standing major Cobb angle for this patient series was 46°. Mean intra-observer measurement error for endplate inclination was 1.6°. Following loading, initially highly wedged discs demonstrated a smaller change in wedge angle, than less wedged discs for certain spinal levels (+2,+1,-2 relative to the apex, (p<0.05)). Highly wedged discs were observed near the apex of the curve, which corresponded to lower joint compliance in the apical region. While individual patients exhibit substantial variability in disc wedge angles and joint compliance, overall there is a pattern of increased disc wedging near the curve apex, and reduced joint compliance in this region. Approaches such as this can provide valuable biomechanical data on in vivo spinal biomechanics of the scoliotic spine, for analysis of deformity progression and surgical planning. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up.

    PubMed

    Chang, Dong-Gune; Yang, Jae Hyuk; Lee, Jung-Hee; Kim, Jin-Hyok; Suh, Seung-Woo; Ha, Kee-Yong; Suk, Se-Il

    2016-08-01

    OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4-18.0 years), and the mean length of follow-up was 12.8 years (range 10.1-18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

  10. The efficacy of rib-based distraction with VEPTR in the treatment of early-onset scoliosis in patients with arthrogryposis.

    PubMed

    Astur, Nelson; Flynn, John M; Flynn, John M; Ramirez, Norman; Glotzbecker, Michael; van Bosse, Harold J; Hoashi, Jane S; d'Amato, Charles R; Kelly, Derek M; Warner, William C; Sawyer, Jeffrey R

    2014-01-01

    Although arthrogryposis multiplex congenital (AMC) is a rare condition, rapidly progressive scoliosis is common in children with AMC. Only a limited number of studies characterize the nature of these curves, and even fewer describe surgical outcomes. To determine efficacy or rib-based distraction in these patients, we reviewed the outcomes of the use of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) device in what we believe is the first study to report this. Search of the Chest Wall Spinal Deformity Study Group database identified 10 children with AMC and early-onset scoliosis who were treated with the VEPTR device at 6 different pediatric health centers. The 7 female and 3 male patients had their initial surgery at an average age of 5 years. Mean follow-up was 4.2 years. The most common curve was from T5 to L2. After initial VEPTR insertion, the scoliosis decreased from a mean of 67 to 43 degrees (37% correction) and kyphosis from 65 to 48 degrees (29% correction). The mean proximal junctional kyphosis after initial insertion was 33 degrees. At final follow-up, scoliosis and kyphosis were 55 degrees (17% correction) and 62 degrees (8% correction), respectively. Spinal growth during the treatment period showed a mean T1-S1 increase of 4.2 cm or approximately 1 cm/y. In the 62 procedures performed over the course of the study period, 6 complications occurred in 4 patients: 3 infections, 2 rib failures, and 1 implant failure. Six patients had proximal junctional kyphosis of ≥45 degrees at the last follow-up. In children with AMC, rib-based distraction using the VEPTR is an effective treatment method for controlling scoliosis and kyphosis and maintaining thoracic growth, but proximal junctional kyphosis remains a problem.

  11. Results of esophagogastrectomy for carcinoma in cirrhotic patients. A series of 23 consecutive patients.

    PubMed Central

    Fekete, F; Belghiti, J; Cherqui, D; Langonnet, F; Gayet, B

    1987-01-01

    Esophagogastrectomy for carcinoma of the esophagus or cardia has been performed in 23 patients with histologically proven hepatic cirrhosis. All but two patients were classified as Child's class A and all but three had a prothrombin time over 60% of normal values. Twenty-two esophagogastrostomies were performed through a separate abdominal and right thoracic approach in 15 patients, a left thoracoabdominal approach in five patients, and without thoracotomy in two patients. One patient had a colon interposition. Six patients died after operation (26%) as a result of anastomotic leakage in two patients, hepatorenal in three patients and portal thrombosis in one patient. The type of procedure did not influence mortality. The most common postoperative complication was the development of ascites (65%), and when associated with hepatorenal syndrome there was a significant mortality (p less than 0.05). Sepsis was present in the terminal stages of all nonsurvivors. A prothrombin time less than or equal to 60% of normal values was the only significant preoperative predictive factor of mortality, with none of the three patients surviving below this level (p less than 0.05). It is concluded that the presence of cirrhosis is not a contraindication to esophagogastrectomy for carcinoma when curative resection can be undertaken. Hepatic reserve is the determinant factor of operative prognosis. Operative risk is acceptable if patients are classified as Child's class A and prothrombin time is over 60% of normal values. Operation should be delayed when acute alcoholic hepatitis is present. Intraoperative discovery of cirrhosis is not a contraindication to resection where the above criteria are met. This strict selection allows one to anticipate a lower mortality rate. PMID:3606234

  12. Development of CAD/CAM Based Brace Models for the Treatment of Patients with Scoliosis-Classification Based Approach versus Finite Element Modelling

    PubMed Central

    Kleban, Alexander

    2015-01-01

    Study Design Retrospective controlled cohort study comparing the in-brace correction of two samples of scoliosis patients with braces of different computer aided design (CAD). Purpose In-brace correction and compliance correlate with outcome. The more standardized CAD braces that are available should enable improved in-brace correction and outcome. This study compared recent CAD brace developments with respect to in-brace corrections. Overview of Literature A 2013 randomized controlled trial demonstrated that 72% of a population complying to Scoliosis Research Society inclusion criteria on bracing did not progress using braces (mainly Boston braces) used in the United States and Canada with moderate corrective effect. Methods In-brace corrections achieved in a sample of patients fulfilling the inclusion criteria for studies on bracing using the classification based approach (CBA) were compared to the recent individual CAD/computer aided manufacturing bracing based on finite element modelling approach (FEMA). Results In-brace corrections using the different approaches differed widely. CBA in-brace corrections were 66% of the initial value. FEMA in-brace correction was 42% of the initial value. Conclusions Considering the fact that in-brace correction (and compliance) determines the end result of bracing in the treatment of scoliosis, scoliosis braces based on CBA are superior to the FEMA and the standard plaster based brace applications. PMID:26435781

  13. Development of CAD/CAM Based Brace Models for the Treatment of Patients with Scoliosis-Classification Based Approach versus Finite Element Modelling.

    PubMed

    Weiss, Hans-Rudolf; Kleban, Alexander

    2015-10-01

    Retrospective controlled cohort study comparing the in-brace correction of two samples of scoliosis patients with braces of different computer aided design (CAD). In-brace correction and compliance correlate with outcome. The more standardized CAD braces that are available should enable improved in-brace correction and outcome. This study compared recent CAD brace developments with respect to in-brace corrections. A 2013 randomized controlled trial demonstrated that 72% of a population complying to Scoliosis Research Society inclusion criteria on bracing did not progress using braces (mainly Boston braces) used in the United States and Canada with moderate corrective effect. In-brace corrections achieved in a sample of patients fulfilling the inclusion criteria for studies on bracing using the classification based approach (CBA) were compared to the recent individual CAD/computer aided manufacturing bracing based on finite element modelling approach (FEMA). In-brace corrections using the different approaches differed widely. CBA in-brace corrections were 66% of the initial value. FEMA in-brace correction was 42% of the initial value. Considering the fact that in-brace correction (and compliance) determines the end result of bracing in the treatment of scoliosis, scoliosis braces based on CBA are superior to the FEMA and the standard plaster based brace applications.

  14. Conjunctival nevi: clinical features and natural course in 410 consecutive patients.

    PubMed

    Shields, Carol L; Fasiuddin, Airaj F; Fasiudden, Airey; Mashayekhi, Arman; Shields, Jerry A

    2004-02-01

    To describe the clinical features of a conjunctival nevus and to evaluate the lesion for changes in color and size over time. Retrospective, observational, noncomparative case series. Four hundred ten consecutive patients with conjunctival nevi. The 2 main outcome measures were changes in tumor color and size. Of the 410 patients, 365 (about 89%) were white, 23 (about 6%) were African American, 8 (2%) were Asian, 8 (2%) were Indian, and 6 (1%) were Hispanic. The iris color was brown in 55% (229/418), blue in 20% (85/418), green in 20% (83/418), and not indicated in 5% (21/418). The nevus was brown in 65%, tan in 19%, and completely nonpigmented in 16%. The anatomical location of the nevus was the bulbar conjunctiva (302 eyes, 72%), caruncle (61 eyes, 15%), plica semilunaris (44 eyes, 11%), fornix (6 eyes, 1%), tarsus (3 eyes, 1%), and cornea (2 eyes, <1%). The bulbar conjunctival lesions most commonly abutted the corneoscleral limbus. The nevus quadrant was temporal (190 eyes, 46%), nasal (184 eyes, 44%), superior (23 eyes, 6%), and inferior (21 eyes, 5%). Additional features included intralesional cysts (65%), feeder vessels (33%), and visible intrinsic vessels (38%). Cysts were clinically detected in 70% of histopathologically confirmed compound nevi, 58% of the subepithelial nevi, 40% of the junctional nevi, and 0% of the blue nevi. Of the 149 patients who returned for periodic observation for a mean of 11 years, the lesion color gradually became darker in 5% (7 patients), lighter in 8% (12 patients), and was stable in 87% (130 patients). The lesion size was larger in 7% (10 patients), appeared smaller in 1% (1 patient), and was stable in 92% (137 patients). There were 3 patients who developed malignant melanoma from a preexisting compound nevus (2 cases) or blue nevus (1 case) over a mean interval of 7 years. Conjunctival nevus is a benign tumor most often located at the nasal or temporal limbus and rarely in the fornix, tarsus, or cornea. Over time, a change

  15. Clinicopathological Features of Cervical Esophageal Cancer: Retrospective Analysis of 63 Consecutive Patients Who Underwent Surgical Resection.

    PubMed

    Saeki, Hiroshi; Tsutsumi, Satoshi; Yukaya, Takafumi; Tajiri, Hirotada; Tsutsumi, Ryosuke; Nishimura, Sho; Nakaji, Yu; Kudou, Kensuke; Akiyama, Shingo; Kasagi, Yuta; Nakashima, Yuichiro; Sugiyama, Masahiko; Sonoda, Hideto; Ohgaki, Kippei; Oki, Eiji; Yasumatsu, Ryuji; Nakashima, Torahiko; Morita, Masaru; Maehara, Yoshihiko

    2017-01-01

    The objectives of this retrospective study were to elucidate the clinicopathological features and recent surgical results of cervical esophageal cancer. Cervical esophageal cancer has been reported to have a dismal prognosis. Accurate knowledge of the clinical characteristics of cervical esophageal cancer is warranted to establish appropriate therapeutic strategies. The clinicopathological features and treatment results of 63 consecutive patients with cervical esophageal cancer (Ce group) who underwent surgical resection from 1980 to 2013 were analyzed and compared with 977 patients with thoracic or abdominal esophageal cancer (T/A group) who underwent surgical resection during that time. Among the patients who received curative resection, the 5-year overall and disease-specific survival rates of the Ce patients were significantly better than those of the T/A patients (overall: 77.3% vs 46.5%, respectively, P = 0.0067; disease-specific: 81.9% vs 55.8%, respectively, P = 0.0135). Although total pharyngo-laryngo-esophagectomy procedures were less frequently performed in the recent period, the rate of curative surgical procedures was markedly higher in the recent period (2000-1013) than that in the early period (1980-1999) (44.4% vs 88.9%, P = 0.0001). The 5-year overall survival rate in the recent period (71.5%) was significantly better than that in the early period (40.7%, P = 0.0342). Curative resection for cervical esophageal cancer contributes to favorable outcomes compared with other esophageal cancers. Recent surgical results for cervical esophageal cancer have improved, and include an increased rate of curative resection and decreased rate of extensive surgery.

  16. Imaging appearance of the lateral rectus-superior rectus band in 100 consecutive patients without strabismus.

    PubMed

    Patel, S H; Cunnane, M E; Juliano, A F; Vangel, M G; Kazlas, M A; Moonis, G

    2014-09-01

    The lateral rectus-superior rectus band is an orbital connective tissue structure that has been implicated in a form of strabismus termed sagging eye syndrome. Our purpose was to define the normal MR imaging and CT appearance of this band in patients without strabismus. Orbital MR imaging and CT examinations in 100 consecutive patients without strabismus were evaluated. Readers graded the visibility of the lateral rectus-superior rectus band on coronal T1WI, coronal STIR, and coronal CT images. Readers determined whether the band demonstrated superotemporal bowing or any discontinuities and whether a distinct lateral levator aponeurosis was seen. Reader agreement was assessed by κ coefficients. Association between imaging metrics and patient age/sex was calculated by using the Fisher exact test. The lateral rectus-superior rectus band was visible in 95% of coronal T1WI, 68% of coronal STIR sequences, and 70% of coronal CT scans. Ninety-five percent of these bands were seen as a continuous, arc-like structure extending from the superior rectus/levator palpebrae muscle complex to the lateral rectus muscle; 24% demonstrated superotemporal bowing; and in 82% of orbits, a distinct lateral levator aponeurosis was visible. Increasing patient age was negatively associated with lateral rectus-superior rectus band visibility (P=.03), positively associated with lateral rectus-superior rectus band superotemporal bowing (P=.03), and positively associated with lateral levator aponeurosis visibility (P=.01). The lateral rectus-superior rectus band is visible in most patients without strabismus on coronal T1WI. The age effect with respect to its visibility and superotemporal bowing could represent age-related connective tissue degeneration. © 2014 by American Journal of Neuroradiology.

  17. Spinal stab injury with retained knife blades: 51 Consecutive patients managed at a regional referral unit.

    PubMed

    Enicker, Basil; Gonya, Sonwabile; Hardcastle, Timothy C

    2015-09-01

    Spinal stab wounds presenting with retained knife blades (RKB) are uncommon, often resulting in spinal cord injury (SCI) with catastrophic neurological consequences. The purpose of this study is to report a single unit's experience in management of this pattern of injury at this regional referral centre. Retrospective review of medical records identified 51 consecutive patients with spinal stabs presenting with a RKB at the Neurosurgery Department at Inkosi Albert Luthuli Central Hospital between January 2003 and February 2015. The data was analyzed for patient characteristics, level of the RKB, neurological status using the ASIA impairment scale, associated injuries, radiological investigations, management, hospital length of stay, complications and mortality. The mean age was 28±10.9 years (range 14-69), with 45 (88%) males (M: F=7.5:1). The median Injury Severity Score was 16 (range 4-26). RKB were located in the cervical [9,18%], thoracic [38,74%], lumbar [2,4%] and sacral [2,4%] spine. Twelve patients (24%) sustained complete SCI (ASIA A), while 21 (41%) had incomplete (ASIA B, C, D), of which 17 had features of Brown-Sequard syndrome. Eighteen (35%) patients were neurologically intact (ASIA E). There were 8 (16%) associated pneumothoraces and one vertebral artery injury. Length of hospital stay was 10±7.1 days (range 1-27). One patient (2%) died during this period. Stab injuries to the spine presenting with RKB are still prevalent in South Africa. Resources should be allocated to prevention strategies that decrease the incidence of inter-personal violence. All RKBs should be removed in the operating theatre by experienced surgeons to minimise complications. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Complications and Unfavorable Clinical Outcomes in Obese and Overweight Patients Treated for Adult Lumbar or Thoracolumbar Scoliosis With Combined Anterior/Posterior Surgery.

    PubMed

    Yagi, Mitsuru; Patel, Ravi; Boachie-Adjei, Oheneba

    2015-07-01

    Combined anterior/posterior (A/P) spinal fusion with instrumentation has been used for many years in the treatment of adult thoracolumbar and lumbar (TL/L) scoliosis. However, the risk factors for complications and poor clinical outcomes with this procedure are not well known. To assess the risk factors for poor clinical outcomes in a series of adult lumbar or scoliosis patients undergoing combined A/P-instrumented spinal fusion. This study was a retrospective case series of surgically treated adult lumbar or thoracolumbar scoliosis patients. From 1998 to 2006, 57 patients with diagnoses of adult idiopathic scoliosis or degenerative TL/L scoliosis underwent combined A/P spinal instrumentation and fusion at 1 institution, performed by 1 senior author. The preoperative and postoperative outcome measurements included self-report measurements, physiological measurements, and functional measurements. A retrospective review of this patient group was performed to evaluate patient satisfaction, functional outcomes, pain, curve progression, and complications. Radiographic measurements included coronal balance, sagittal vertical axis, Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence preoperatively, immediately postoperatively, and during follow-up. In terms of risk factors, bone mineral density, body mass index, age, kyphosis, and fusion to the sacrum were reviewed. Postoperative Scoliosis Research Society Patient Questionnaire outcome scores, Oswestry Disability Index (ODI), and anterior surgical site pain (ASSP) were also evaluated. Means were compared with the Student t test and the χ test. Logistic regression analyses were used to predict the probabilities and the odds ratios (ORs) of the risk factors for poor clinical outcomes. A P-value of <0.05 with a confidence interval of 95% was considered significant. Fifty patients had adult idiopathic scoliosis, and 7 patients had degenerative scoliosis. The average age at surgery was 53.8 years (34-74 y

  19. Diagnosis and treatment of adolescent idiopathic scoliosis.

    PubMed

    Burton, Monique S

    2013-11-01

    Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees on radiography that is typically associated with trunk rotation. The three major types of scoliosis are congenital, idiopathic, and neuromuscular. Idiopathic scoliosis is divided into three subcategories based on the age of onset. Infantile idiopathic scoliosis affects patients younger than 3 years, juvenile idiopathic scoliosis appears in children between 3 and 10 years, and adolescent idiopathic scoliosis (AIS) occurs in skeletally immature patients older than 10 years. AIS is the most common form of idiopathic scoliosis. Approximately 2% to 4% of children aged 10 to 16 years have some degree of spinal curvature. Although some researchers view routine screening for AIS as controversial, well-child examinations and sports physicals are an optimal time to evaluate for AIS in the clinical setting. In 2008, the American Academy of Orthopaedic Surgeons, the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the American Academy of Pediatrics convened a task force to review the issues related to scoliosis screening and issued an information statement concluding that although screening has limitations, the potential benefits that patients with idiopathic scoliosis receive from early treatment can be substantial. Recommendations are now that females are screened twice, at age 10 and 12 years, and males once at age 13 or 14 years. Screening during routine well-child examinations and/or school-based evaluations will help identify patients who need ongoing monitoring. The evaluation of curvatures in conjunction with the level of skeletal maturity will help to guide the management of the curvature. Copyright 2013, SLACK Incorporated.

  20. Differences in pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification.

    PubMed

    Akkaya, Sezen; Özkurt, Yelda Buyru; Aksoy, Sibel; Kökçen, Hatice Kübra

    2016-07-23

    The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract. The other eye was operated on within 3 months by the same surgeon (mean interval 1.9 ± 1.1 months). All patients were asked to grade their pain experience during induction and maintenance of anesthesia and also during the phacoemulsification surgery, using a visual analogue scale (VAS) from 0 (no pain) to 10 (unbearable pain) administered after the surgery. The cooperation of the patient was graded from 0 (no event) to 3 (markedeye and head movement and lid squeezing) by the attending surgeon. The VAS scores and cooperation scores of the patients were the outcome measurements. The mean pain score was 2.11 ± 0.79 in the first eye and 3.33 ± 0.80 in the second eye during the administration of sub-Tenon's anesthesia, and 1.50 ± 0.60 in the first eye and 2.10 ± 0.57 in the second eye during the phacoemulsification surgery. The patient cooperation score was 1.60 ± 0.75 in the first surgery and 2.08 ± 0.72 in the second surgery. The differences between the first and second surgeries were statistically significant for all outcome measures (p < 0.01). Patients who previously underwent phaco surgery in one eye experienced more pain and showed worse cooperation during the phaco surgery in the second eye, especially if there was a short time between the surgeries, viz., less than 3 months. Therefore, if the surgeon has difficulty in the first operation gaining the patient's cooperation, the surgeon must be careful: if contralateral eye

  1. The functional intraoral Glasgow scale in floor of mouth carcinoma: longitudinal assessment of 62 consecutive patients.

    PubMed

    Ellabban, Mohamed A; Shoaib, Taimur; Devine, John; McMahon, Jeremy; Morley, Stephen; Adly, Osama A; Farrag, Sherif H; Moati, Taha A; Soutar, David

    2013-03-01

    The functional integrity of the floor of the mouth (FOM) is essential in maintaining tongue mobility, deglutition, and control and disposal of saliva. The present study focused on reporting oral function using functional intraoral Glasgow scale (FIGS) in patients who had surgical ablation and reconstruction of FOM carcinoma with or without chemo-radiotherapy. The study included patients who had surgical treatment of floor of mouth cancer in two regional head and neck units in Glasgow, UK between January 2006 and August 2007. Patients were assessed using FIGS before surgery, 2 months, 6 months and 1 year after surgery. It is a five-point scale self-questionnaire to allow patients to self-assess speech, chewing and swallowing. The maximum total score is 15 points. The influence of socio-demographic parameters, tumour characteristics and surgical parameters was addressed in the study. A total of 62 consecutive patients were included in the study; 41 (66.1 %) were males and 21 (33.9 %) were females. The patients' mean age at the time of diagnosis was 60.6 years. Fifty (80.6 %) patients had unilateral origin of FOM tumours and 10 (19.4 %) had bilateral origin. Peroral approach was the most common approach used in 35 (56.4 %) patients. The mean preoperative FIGS score was 14. Two months after surgery, it droped to 9.4 then started to increase gradually thereafter and recorded 10.1 at 6 months and 11 at 1 year. Unilateral FOM resection recorded better score than bilateral and lateral FOM tumours than anterior at 1 year postoperatively. Furthermore, direct closure showed better functional outcome than loco-regional and free flaps. The FIGS is a simple and comprehensive way of assessing a patient's functional impairment following surgery in the FOM. Tumour site and size, surgical access, surgical resection and method of reconstruction showed significant influence on oral function following surgical resection. A well-designed rehabilitation programme is required to improve

  2. Chiropractic Rehabilitation for Adolescent Idiopathic Scoliosis: End-of-Growth and Skeletal Maturity Results

    PubMed Central

    Morningstar, Mark W.; Dovorany, Brian; Stitzel, Clayton J.; Siddiqui, Aatif

    2017-01-01

    The aim of this study was to evaluate the radiographic outcomes obtained in a sample of patients treated with a chiropractic scoliosis-specific exercise program for patients with adolescent idiopathic scoliosis. Patients were treated and subsequently followed through skeletal maturity, and their results were reported in accordance with the SOSORT Consensus Guidelines. A total of 60 patient charts were consecutively selected when they met inclusion criteria. Cobb angle measurements and Risser staging were collected on all images. Using SOSORT criteria, 51.7% of patients achieved curve correction and 38.3% achieved stabilization. In the curve correction group, average total correction was 12.75°. A small number of sampled patients’ curves progressed, with a 13% failure rate based upon patients who dropped out before skeletal maturity combined with those who had progressed at skeletal maturity. Future studies are needed to corroborate these observations. PMID:28243430

  3. DiscoGel® in patients with discal lumbosciatica. Retrospective results in 25 consecutive patients.

    PubMed

    Léglise, A; Lombard, J; Moufid, A

    2015-09-01

    Discogenic lumbosciatica is a common disorder in patients between 30 and 40 years old. Because of the frequency and socio-professional impact of this entity, it represents a real public health problem. DiscoGel® is a class III medical device used for nucleolysis to avoid discectomy. The goal of this study was to evaluate the effectiveness of this treatment in patients with discogenic lumbosciatica following unsuccessful conservative medical treatment. This is a retrospective, single-center study including 25 patients who were treated with DiscoGel® between 2010 and 2011 at Niort Hospital, France. The severity of lumbar and radicular pain was assessed by a verbal numeric scale (VNS) and patient satisfaction. Patients were classified as successes or failures. Treatment was found to reduce the severity of lumbar pain in 73% and of radicular pain in 80% of patients in the success group. Treatment was a failure in 64% of patients. A comparison of the two groups showed that a preoperative MODIC 2 MRI signal of the adjacent vertebral end plate was significantly associated with treatment failure (Chi(2)=8572, P < 0.01). The VNS for lumbar pain and radicular pain decreased in 42% and 50% of patients respectively after the use of DiscoGel®. In our series, DiscoGel® treatment was unsuccessful for discogenic lumbosciatica in 16 patients. These results do not support others in the literature. A lack of statistical power could partly explain these results. The most important result of this study is found in the subgroup analysis which suggests that indications for DiscoGel® treatment could be modified in the future in relation to preoperative imaging data. 4. Copyright © 2015. Published by Elsevier Masson SAS.

  4. Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

    SciTech Connect

    Anselmetti, Giovanni Carlo Manca, Antonio; Montemurro, Filippo; Hirsch, Joshua; Chiara, Gabriele; Grignani, Giovanni Carnevale Schianca, Fabrizio Capaldi, Antonio Rota Scalabrini, Delia; Sardo, Elena Debernardi, Felicino; Iussich, Gabriella; Regge, Daniele

    2012-02-15

    Purpose: Percutaneous vertebroplasty (PV) is a minimally invasive procedure involving the injection of bone cement within a collapsed vertebral body. Although this procedure was demonstrated to be effective in osteoporosis and metastases, few studies have been reported in cases of multiple myeloma (MM). We prospectively evaluated the safety and efficacy of PV in the treatment of vertebral compression fractures (VCFs) resulting from MM. Materials and Methods: PV was performed in 106 consecutive MM patients who had back pain due to VCFs, the treatment of which had failed conservative therapies. Follow-up (28.2 {+-} 12.1 months) was evaluated at 7 and 15 days as well as at 1, 3, 6, 12, 18, and every 6 months after PV. Visual analog scale (VAS) pain score, opioid use, external brace support, and Oswestry Disability Index (ODI) score were recorded. Results: The median pretreatment VAS score of 9 (range 4-10) significantly (P < 0.001) decreased to 1 (range 0-9) after PV. Median pre-ODI values of 82% (range 36-89%) significantly improved to 7% (range 0-82%) (P < 0.001). Differences in pretreatment and posttreatment use of analgesic drug were statistically significant (P < 0.001). The majority of patients (70 of 81; 86%) did not use an external brace after PV (P < 0.001). Conclusion: PV is a safe, effective, and long-lasting procedure for the treatment of vertebral compression pain resulting from MM.

  5. Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results.

    PubMed

    Favretti, Franco; Segato, Gianni; Ashton, David; Busetto, Luca; De Luca, Maurizio; Mazza, Marco; Ceoloni, Andrea; Banzato, Oscar; Calo, Elisa; Enzi, Giuliano

    2007-02-01

    This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up. Long-term results of LAGB with a high follow-up rate are not common. Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 +/- 24 kg, mean BMI 46.2 +/- 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities, conversion, short- and long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated patients versus 821 treated by medical therapy. Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1), sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%: due to technical difficulties (1.2) and due to intraoperative complications (0.5). Together with the re-positioning of the band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning 50 (2.7 %), and other 1 (0.05 %). Port-related complications occurred in 200 patients (11.2%). 41 patients (2.3%) underwent further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and a biliopancreatic diversion with gastric preservation ("bandinaro") in 24 (1.3%). Weight in kg was 103.7 +/- 21.6, 102.5 +/- 22.5, 105.0 +/- 23.6, 106.8 +/- 24.3, 103.3 +/- 26.2 and 101.4 +/- 27.1 at 1, 3, 5, 7, 9, 11 years

  6. Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients.

    PubMed

    Sicilia, Alberto; Cuesta, Susana; Coma, Gerardo; Arregui, Ignacio; Guisasola, Cristina; Ruiz, Eduardo; Maestro, Antonio

    2008-08-01

    In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression. Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material. Thirty-five subjects out of 1500 implant patients treated and/or examined (2002-2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out. Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight). Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.

  7. Secondary gliosarcoma after diagnosis of glioblastoma: clinical experience with 30 consecutive patients.

    PubMed

    Han, Seunggu J; Yang, Isaac; Otero, Jose J; Ahn, Brian J; Tihan, Tarik; McDermott, Michael W; Berger, Mitchel S; Chang, Susan M; Parsa, Andrew T

    2010-05-01

    Gliosarcoma can arise secondarily, after conventional adjuvant treatment of high-grade glioma. The current literature on the occurrence of secondary gliosarcoma (SGS) after glioblastoma multiforme (GBM) is limited, with only 12 reported cases. The authors present a large series of histologically confirmed SGSs, with follow-up to describe the clinical and radiological presentation, pathological diagnosis, and treatment outcomes. Gliosarcoma cases were identified using the University of California, San Francisco's Departments of Neurological Surgery and Neuropathology databases. Through a retrospective chart review, cases of gliosarcoma were considered SGS if the following inclusion criteria were met: 1) the patient had a previously diagnosed intracranial malignant glioma that did not have gliosarcoma components; and 2) the histopathological tissue diagnosis of the recurrence confirmed gliosarcoma according to the most current WHO criteria. Extensive review of clinical, surgical, and pathology notes was performed to gather clinical and pathological data on these cases. Thirty consecutive patients in whom SGS had been diagnosed between 1996 and 2008 were included in the analysis. All patients had previously received a diagnosis of malignant glioma. For the initial malignant glioma, all patients underwent resection, and 25 patients received both external-beam radiation and chemotherapy. Three patients received radiotherapy alone, 1 patient was treated with chemotherapy alone, and 1 patient's tumor rapidly recurred as gliosarcoma, requiring surgical intervention prior to initiation of adjuvant therapy. The median time from diagnosis of the initial tumor to diagnosis of gliosarcoma was 8.5 months (range 0.5-25 months). All but 1 patient (who only had a biopsy) underwent a second operation for gliosarcoma; 8 patients went on to receive radiotherapy (4 had brachytherapy, 3 had external-beam radiation, and 1 had Gamma Knife surgery); and 14 patients received additional

  8. [How to treat an idiopatic scoliosis].

    PubMed

    Korbelář, Petr

    2016-01-01

    Scoliosis is a three-dimensional deformity of the spine. In its most common form idiopathic scoliosis (70 to 80 % of cases), the causes are unknown. It is defined as a curve of at least 10°, measured on a standing radiograph using the Cobb technique. A severe form of scoliosis is more commonly found in females. Typically scoliosis does not cause any health problems during growth (except for extreme cases). Patients are generally treated in an attempt to halt the progressive nature of the deformity. We present a treatment of different kind of curves.By the end of growth, the risk of health and social problems in adulthood increases significantly. Problems include reduced quality of life, disability, pain, increased cosmetic deformity, functional limitations, sometimes pulmonary problems, and progression during adulthood. It is necessary to start with the treatment ASAP, because the management of scoliosis includes the prevention of secondary problems associated with the deformity.

  9. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients.

    PubMed Central

    Shields, C L

    2000-01-01

    OBJECTIVE: To identify the risk factors of conjunctival malignant melanoma that predict local tumor recurrence, orbital exenteration, distant metastasis, and tumor-related mortality. DESIGN: The study group consisted of 150 consecutive patients with a diagnosis of conjunctival melanoma. The clinical parameters of the patient, tumor, and treatment were analyzed in a nonrandomized fashion for their relation to 4 main outcome measures using Cox proportional hazards regression models. RESULTS: The Kaplan-Meier estimate of local tumor recurrence was 26% at 5 years, 51% at 10 years, and 65% at 15 years. The mean number of recurrences per patient was 1 (median, 0). Ninety-eight patients (65%) had no recurrences, 28 patients (19%) had 1, 11 patients (7%) had 2, 5 patients (3%) had 3, and 8 patients (5%) had 4 or more recurrences. According to multivariate analysis, the factors that predicted local tumor recurrence were the location of the melanoma (not touching the limbus) (P = .01) and tumor-margin pathology (lateral margin involved) (P = .02). Multivariate analysis for features predictive of ultimate exenteration included initial visual acuity (20/40 or worse) (P = .0007), melanoma color (red) (P = .01), and melanoma location (not touching the limbus) (P = .02). Tumor metastasis occurred in 16% of patients at 5 years, 26% at 10 years, and 32% at 15 years. Metastasis was initially in the regional lymph nodes in 17 cases, brain in 4, liver in 3, lung in 2, and disseminated in 1 case. Risks for metastases with use of multivariate analysis included tumor-margin pathology (lateral margin involved) (P = .002) and melanoma location (not touching limbus) (P = .04). Tumor-related death occurred in 7% of patients at 5 years and 13% at 8 years. Risk factors for death with use of multivariate analysis included initial symptoms (lump) (P = .004) and pathologic findings (de novo melanoma without primary acquired melanosis) (P = .05). In a series of univariate analyses, the technique

  10. Measurement properties of translated versions of the Scoliosis Research Society-22 Patient Questionnaire, SRS-22: a systematic review.

    PubMed

    Monticone, Marco; Nava, Claudia; Leggero, Vittorio; Rocca, Barbara; Salvaderi, Stefano; Ferrante, Simona; Ambrosini, Emilia

    2015-08-01

    The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) has been translated into various languages and tested in patients with scoliosis. However, the translations and their psychometric properties have never been systematically reviewed. This study aimed to evaluate the psychometric properties and to provide the current level of evidence of all the available translations of the SRS-22 using the "COnsensus-based Standards for the selection of health status Measurement INstruments" (COSMIN). A systematic review was performed. The PubMed, Medline, EMbase, and CINAHL databases were searched for articles concerning the translations of the SRS-22 and/or evaluating any of their measurement properties. Two reviewers independently assessed the methodological quality and the psychometric estimates of the selected studies by using the 4-point rating scale COSMIN checklist and a validated quality assessment criteria, respectively. The level of evidence of each psychometric property per language was determined combining COSMIN outcomes and psychometric results. The search strategy led to 24 articles evaluating the SRS-22 in 17 different languages. The methodological quality of the properties was mostly poor to fair, and there was a lack of information regarding them. The overall assessment was positive in 42.5 % of cases. The level of evidence resulted in a limited positive evidence in 11 languages. The Chinese (traditional), Dutch, Italian, Norwegian, and Spanish translations are advisable; the Greek, Japanese, Korean, Persian, Thai, and Turkish translations showed encouraging results but should be used with caution; the Brazilian, Chinese (simplified), Polish, and Swedish translations showed contradictory or scarce results, and no suggestions can be formulated; the French Canadian and German translations did not provide methodologically sound information. Further attention should be given to cross-cultural and structural validity, hypothesis testing, and

  11. Evaluation of a Patient-Specific Finite-Element Model to Simulate Conservative Treatment in Adolescent Idiopathic Scoliosis.

    PubMed

    Vergari, Claudio; Ribes, Gwenael; Aubert, Benjamin; Adam, Clayton; Miladi, Lotfi; Ilharreborde, Brice; Abelin-Genevois, Kariman; Rouch, Philippe; Skalli, Wafa

    2015-01-01

    Retrospective validation study. To propose a method to evaluate, from a clinical standpoint, the ability of a finite-element model (FEM) of the trunk to simulate orthotic correction of spinal deformity and to apply it to validate a previously described FEM. Several FEMs of the scoliotic spine have been described in the literature. These models can prove useful in understanding the mechanisms of scoliosis progression and in optimizing its treatment, but their validation has often been lacking or incomplete. Three-dimensional (3D) geometries of 10 patients before and during conservative treatment were reconstructed from biplanar radiographs. The effect of bracing was simulated by modeling displacements induced by the brace pads. Simulated clinical indices (Cobb angle, T1-T12 and T4-T12 kyphosis, L1-L5 lordosis, apical vertebral rotation, torsion, rib hump) and vertebral orientations and positions were compared to those measured in the patients' 3D geometries. Errors in clinical indices were of the same order of magnitude as the uncertainties due to 3D reconstruction; for instance, Cobb angle was simulated with a root mean square error of 5.7°, and rib hump error was 5.6°. Vertebral orientation was simulated with a root mean square error of 4.8° and vertebral position with an error of 2.5 mm. The methodology proposed here allowed in-depth evaluation of subject-specific simulations, confirming that FEMs of the trunk have the potential to accurately simulate brace action. These promising results provide a basis for ongoing 3D model development, toward the design of more efficient orthoses. Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  12. Estrogen cross-talk with the melatonin signaling pathway in human osteoblasts derived from adolescent idiopathic scoliosis patients.

    PubMed

    Letellier, Kareen; Azeddine, Bouziane; Parent, Stefan; Labelle, Hubert; Rompré, Pierre H; Moreau, Alain; Moldovan, Florina

    2008-11-01

    Adolescent idiopathic scoliosis (AIS) represents the most frequently occurring form of scoliosis that occurs and progresses in puberty. This critical period coincides with many biological changes related to estrogens. The aim of this study was to determine the effect of 17-beta-estradiol on the responsiveness of AIS osteoblasts to melatonin and the cross-talk between estrogen and melatonin at the levels of the G(S)alpha and G(i)alpha proteins. Human osteoblasts derived from AIS (n = 40) and control patients (n = 10) were first screened for their functional response to the melatonin and 17-beta-estradiol. In response to the 17-beta-estradiol in a specific group of scoliotic patients, the level of 3',5'-cyclic adenosine monophosphate (cAMP) was significantly decreased when compared with the level observed in the presence of increasing concentrations of melatonin alone. Ours results provide strong evidence of the cross-talk between 17-beta-estradiol and melatonin signaling in human AIS osteoblasts. These results indicate a novel role for 17-beta-estradiol and melatonin in AIS, controlling the coupling of G(S)alpha protein and MT2 receptor on human osteoblasts. We found that the increased cAMP levels induced by melatonin can be corrected by the treatment of the cells with 17-beta-estradiol. Thus, estrogens or estrogen receptor agonists become important compounds to consider in AIS osteoblast cell functioning. Consequently, our results add a new facet to the understanding the role and function of melatonin in AIS.

  13. Congenital scoliosis: etiology and associations.

    PubMed

    Hensinger, Robert N

    2009-08-01

    Literature review. To provide a current overview of congenital scoliosis and associated conditions. The etiology of congenital scoliosis is unknown. A variety of factors have been implicated in the development of vertebral abnormalities. These factors provide clues to the origin of congenital scoliosis. A search of PubMed, using the keywords congenital scoliosis, etiology, and genetics was performed. Environmental factors, genetics, vitamin deficiency, chemicals, and drugs, singly or in combination, have all been implicated in the development of vertebral abnormalities. Whatever the cause, the physiologic injury occurs early in the embryologic period, well before the development of cartilage and bone. The resulting defects can lead to full or partial fusion or lack of development of the vertebrae, which, in turn, can cause a curvature that, may be progressive during the growth of the child. The origin of congenital scoliosis may be environmental, genetic, or a combination of factors. Research on these various factors continues. Early identification and management of concomitant defects can improve the patient's quality of life.

  14. Tetanus in patients three years of age and up. A personal series of 230 consecutive patients.

    PubMed

    Garnier, M J

    1975-04-01

    My experience with 230 patients with tetanus who were admitted to the intensive care unit of the Hôpital Albert Schweitzer during a period of four years and four months is presented. We have observed a male predominance and the prognostic importance of age. The survival rate of over 84 per cent that we have achieved has resulted from the dedicated care of our nursing personnel and the collaboration of collegues of various specialties. Tetanus antitoxin, 10,000 units, is sufficient. Diazepam provides adequate relaxation and sedation. Gastrostomy and tracheostomy play a considerable role.

  15. Effectiveness and safety of air-filled balloon Heliosphere BAG® in 82 consecutive obese patients.

    PubMed

    Lecumberri, Edurne; Krekshi, Waeel; Matía, Pilar; Hermida, Carlos; de la Torre, Nuria García; Cabrerizo, Lucio; Rubio, Miguel Ángel

    2011-10-01

    Intragastric balloon is a widely used technique to treat obesity that is considered to be more efficient than conservative treatment before bariatric surgery. To describe air-filled balloon (Heliosphere BAG®) effectiveness [absolute weight loss, body mass index (BMI) loss, percentage of body weight loss (BWL), percentage of excess weight loss (EWL)] and complications 6 months after its insertion. Eighty-four consecutive intragastric balloons were placed endoscopically. Individualized nutritional counseling was given. The follow-up was carried out in an endocrinology outpatient clinic. Due to the weight or height data missed in two cases, only 82 patients were included in this report, 63 women with a mean age 39 years (SD, 11.1); mean BMI, 39.1 kg/m(2) (SD, 5.8). The median follow-up was 182 days. The mean weight loss and BMI loss were 14.5 kg (SD, 8.2); and 5.3 kg/m(2) (SD, 2.8), respectively (for difference, p < 0.001). The mean percentage of BWL was 13.4% (SD, 7.0). Of the sample, 70.4% achieved a percentage of BWL >10%. The percentage of EWL reached 33.2% (SD, 19.2). After adjusting by sex and initial BMI, absolute weight loss (p = 0.033), BMI loss (p = 0.034), percentage of BWL (p = 0.034), and percentage of EWL (p = 0.034) were inversely related to age. Absolute weight loss and BMI loss were greater in higher initial BMI, but the percentage of EWL was lower. Two spontaneous deflations occurred (3%), but only one surgical early removal (1.2%) was required. Nausea and vomiting developed in 7.4% of the patients during the first week. Air-filled Heliosphere BAG® has been effective in achieving a relevant loss of body weight.

  16. Risk Factors for Postoperative Morbidity After Totally Robotic Gastric Bypass in 302 Consecutive Patients.

    PubMed

    Fantola, G; Nguyen-Thi, P L; Reibel, N; Sirveaux, M A; Germain, A; Ayav, A; Bresler, L; Zarnegar, R; Brunaud, L

    2015-07-01

    Totally robotic gastric bypass (robotic Roux-en-Y gastric bypass, R-RYGBP) has been adopted in some centers on the basis of large retrospective studies. In view of some data showing higher morbidity and higher costs, some authors have considered that robotic gastric bypass may no longer be justified with the existing system. Although low postoperative complication rates after R-RYGBP have been reported, risk factors for postoperative morbidity have never been evaluated. The goal of this study was to identify risk factors for postoperative morbidity after R-RYGBP. A retrospective analysis of a prospectively maintained database was performed and included 302 consecutive patients after R-RYGBP performed between 2007 and 2013. This subset of patients represented 34 % of all gastric bypass procedures performed during this study period. Univariate and multivariate analyses were performed in order to identify risk factors for postoperative overall morbidity (Clavien scores 1-4 versus 0) and major morbidity (Clavien score ≥3 versus 0-1-2). Postoperative morbidity and mortality rates were 24.4 and 0.6 %, respectively. In multivariate analysis, independent risk factors for overall morbidity were American Society of Anesthesiologists (ASA) score ≥3 (odds ratio (OR) 2.0) and previous bariatric surgery (revisional gastric bypass) (OR 2.0). Independent risk factors for major morbidity (Clavien ≥3) were previous bariatric surgery (revisional gastric bypass) (OR 3.7), low preoperative hematocrit level (OR 0.9), and revisional gastric bypass procedure with concomitant gastric banding removal (OR 5.7). R-RYGBP is prone to increased complications in the setting of a high preoperative ASA score and revisional surgery. This should be taken into consideration by clinicians when evaluating R-RYGBP.

  17. Correlation between Topographic Parameters Obtained by Back Surface Topography Based on Structured Light and Radiographic Variables in the Assessment of Back Morphology in Young Patients with Idiopathic Scoliosis.

    PubMed

    Pino-Almero, Laura; Mínguez-Rey, María Fe; Cibrián-Ortiz de Anda, Rosa María; Salvador-Palmer, María Rosario; Sentamans-Segarra, Salvador

    2017-04-01

    Optical cross-sectional study. To study the correlation between asymmetry of the back (measured by means of surface topography) and deformity of the spine (quantified by the Cobb angle). The Cobb angle is considered the gold standard in diagnosis and follow-up of scoliosis but does not correctly characterize the three-dimensional deformity of scoliosis. Furthermore, the exposure to ionizing radiation may cause harmful effects particularly during the growth stage, including breast cancer and other tumors. Patients aged 13.15±1.96 years (range, 7-17 years; n=88) with Cobb angle greater than 10° were evaluated with X-rays and our back surface topography method through three variables: axial plane (DHOPI), coronal plane (POTSI), and profile plane (PC). Pearson's correlation was applied to determine the correlation between topographic and radiographic variables. One-way analysis of variance and Bonferroni correction were used to compare groups with different grades of scoliosis. Significance was set at p<0.01 and, in some cases, at p<0.05. We detected a positive, statistically significant correlation between Cobb angle with DHOPI (r=0.810) and POTSI (r=0.629) and between PC variables with thoracic kyphosis angle (r=0.453) and lordosis lumbar angle (r=0.275). In addition, we found statistically significant differences for DHOPI and POTSI variables according to the grade of scoliosis. Although the back surface topography method cannot substitute for radiographs in the diagnosis of scoliosis, correlations between radiographic and topographic parameters suggest that it offers additional quantitative data that may complement radiologic study.

  18. Are We Prescribing Our Patients Too Much Pain Medication? Best Predictors of Narcotic Usage After Spinal Surgery for Scoliosis.

    PubMed

    Grant, Daniel R; Schoenleber, Scott J; McCarthy, Alicia M; Neiss, Geraldine I; Yorgova, Petya K; Rogers, Kenneth J; Gabos, Peter G; Shah, Suken A

    2016-09-21

    Physicians play a role in the current prescription drug-abuse epidemic. Surgeons often prescribe more postoperative narcotic pain medication than patients routinely need. Although narcotics are effective for severe, acute, postoperative pain, few evidence-based guidelines exist regarding the routinely required amount and duration of use post-hospital discharge. Patients in a prospective cohort undergoing posterior spinal fusion for idiopathic scoliosis were asked preoperatively to rate their pain level, the level of pain expected each week postoperatively, and their pain tolerance. Post-discharge pain scores and narcotic use were reported at weekly intervals for 4 weeks postoperatively. Demographic data, preoperative Scoliosis Research Society (SRS)-22 scores, operative details, perioperative data, and self-reported pain levels were analyzed with respect to their association with total medication use and refills received. Disposal plans were also assessed. Seventy-two patients were enrolled, and 85% completed the surveys. The mean patient age was 14.9 years; 69% of the patients were female. The cohort was divided into 3 groups on the basis of total medication usage. The mean number of pills used in the middle (average-use) group was 49 pills. In postoperative week 4, narcotic usage was minimal (a mean of 2.9 pills by the highest-use group). Also by this time point, pain scores had, on average, returned to preoperative levels. Older age, male sex, a higher body mass index, and a higher preoperative pain score were associated with increased narcotic use. Sixty-seven percent of the patients planned to dispose of their unused medication, although only 59% of those patients planned on doing so in a manner recommended by the U.S. Food and Drug Administration. Postoperative narcotic dosing may be improved by considering patient age, weight, sex, and preoperative pain score. The precise estimation of individual narcotic needs is complex. Patient and family education on the

  19. Factors associated with spinal fusion after posterior fossa decompression in pediatric patients with Chiari I malformation and scoliosis.

    PubMed

    Mackel, Charles E; Cahill, Patrick J; Roguski, Marie; Samdani, Amer F; Sugrue, Patrick A; Kawakami, Noriaki; Sturm, Peter F; Pahys, Joshua M; Betz, Randal R; El-Hawary, Ron; Hwang, Steven W

    2016-12-01

    OBJECTIVE The authors performed a study to identify clinical characteristics of pediatric patients diagnosed with Chiari I malformation and scoliosis associated with a need for spinal fusion after posterior fossa decompression when managing the scoliotic curve. METHODS The authors conducted a multicenter retrospective review of 44 patients, aged 18 years or younger, diagnosed with Chiari I malformation and scoliosis who underwent posterior fossa decompression from 2000 to 2010. The outcome of interest was the need for spinal fusion after decompression. RESULTS Overall, 18 patients (40%) underwent posterior fossa decompression alone, and 26 patients (60%) required a spinal fusion after the decompression. The mean Cobb angle at presentation and the proportion of patients with curves > 35° differed between the decompression-only and fusion cohorts (30.7° ± 11.8° vs 52.1° ± 26.3°, p = 0.002; 5 of 18 vs 17 of 26, p = 0.031). An odds ratio of 1.0625 favoring a need for fusion was established for each 1° of increase in Cobb angle (p = 0.012, OR 1.0625, 95% CI 1.0135-1.1138). Among the 14 patients older than 10 years of age with a primary Cobb angle exceeding 35°, 13 (93%) ultimately required fusion. Patients with at least 1 year of follow-up whose curves progressed more 10° after decompression were younger than those without curve progression (6.1 ± 3.0 years vs 13.7 ± 3.2 years, p = 0.001, Mann-Whitney U-test). Left apical thoracic curves constituted a higher proportion of curves in the decompression-only group (8 of 16 vs 1 of 21, p = 0.002). CONCLUSIONS The need for fusion after posterior fossa decompression reflected the curve severity at clinical presentation. Patients presenting with curves measuring > 35°, as well as those greater than 10 years of age, may be at greater risk for requiring fusion after posterior fossa decompression, while patients less than 10 years of age may require routine monitoring for curve progression. Left apical thoracic curves

  20. Duchenne muscular dystrophy: the management of scoliosis

    PubMed Central

    Gardner, Adrian C.; Roper, Helen P.; Chikermane, Ashish A.; Tatman, Andrew J.

    2016-01-01

    This study summaries the current management of scoliosis in patients with Duchenne Muscular Dystrophy. A literature review of Medline was performed and the collected articles critically appraised. This literature is discussed to give an overview of the current management of scoliosis within Duchenne Muscular Dystrophy. Importantly, improvements in respiratory care, the use of steroids and improving surgical techniques have allowed patients to maintain quality of life and improved life expectancy in this patient group. PMID:27757431

  1. Early postoperative patient-controlled analgesia ratio predicts 24-hour morphine consumption and pain in children undergoing scoliosis surgery.

    PubMed

    Matava, Clyde T; Crawford, Mark W; Pehora, Carolyne; Naser, Basem; McDonnell, Conor

    2014-01-01

    The identification of patients at risk for developing severe postoperative pain and/or opioid-related side effects is difficult due to a lack of sensitive indicators. The patient-controlled analgesia (PCA) ratio of demands to deliveries is a potential tool for early identification of patients who experience severe postoperative pain. The authors hypothesized that the PCA ratio is able to predict morphine requirement in the first 24 hours after scoliosis surgery. The authors performed a retrospective study of adolescents who had surgery for idiopathic scoliosis. They collected data describing PCA demands and deliveries, morphine consumption, numerical rating scale (NRS) pain scores, opioid related side effects, and duration of hospital stay. Spearman rank analysis assessed association among 4-hour PCA ratios, NRS pain score, and 24-hour morphine consumption. Patients were divided into groups on the basis of PCA ratios <1.5 and ≥1.5. Univariate analysis and multiple regression were used to identify independent factors predictive for increased 24-hour morphine. Mann-Whitney rank-sum and Fisher exact tests were used to compare data. p < 0.05 was considered statistically significant. One hundred forty-seven patients were included in the analysis, mean (SD) age and weight were 15 (1.8) years and 55 (27) kg, respectively. There was a significant positive correlation between the 4-hour PCA ratio and initial 24-hour cumulative morphine consumption (r = 0.33, p = 0.0002). Patients with a 4-hour PCA ratio ≥1.5 demonstrated a significantly greater initial 24-hour morphine consumption (p = 0.0002), greater pain scores at 24 hours after surgery (p = 0.02), a greater incidence of at least one opioid-related side effect within the initial 24 hours after surgery, and a longer duration of hospital stay (p = 0.04) compared with those patients with a 4-hour PCA ratio <1.5. PCA ratio ≥1.5, age, and patient sex were predictive for 24-hour morphine consumption. The authors have

  2. Comparison of Functional Outcome and Quality of Life in Patients With Idiopathic Scoliosis Treated by Spinal Fusion

    PubMed Central

    Fan, Hengwei; Wang, Qifei; Huang, Zifang; Sui, Wenyuan; Yang, Jingfan; Deng, Yaolong; Yang, Junlin

    2016-01-01

    Abstract Longer spinal fusions have been shown to result in improved deformity correction; however, loss of normal flexibility in the fusion area should not be ignored. Current consensus was to achieve a shorter fusion in primary surgery, with the goal of preserving as much of the distal motion segment as possible. However, the correlation between the length of fusion and functional outcome remains controversial. To the best of our knowledge, a previous study has demonstrated the function outcomes and the differences in HRQoL with specific fusion levels. In this cross-sectional study, 172 patients (mean age, 17.8 y) with idiopathic scoliosis treated by spinal fusion (mean time since surgery, 29.7 mo) were included to measure lumbar spine mobility and quality of life using validated outcome instruments in the study population. Patients were assigned to 5 groups according to the lower instrumented vertebra (LIV) level: group A (fusion above L2) 26 patients; group B (fusion to L2) 21 patients; group C (fusion to L3) 46 patients; group D (fusion to L4) 53 patients; and group E (fusion to L5) 26 patients. At each follow-up, patients were asked to complete the Scoliosis Research Society 22 (SRS-22) Questionnaire. Lumbar mobility was assessed using a dual digital inclinometer. Average spinal range of motion (ROM) was 41.4 degrees (SD, 20.7), forward flexion was 29.2 degrees (SD, 15.0), and backward extension was 12.2 degrees (SD, 9.5). The total spinal range of motion and forward flexion dropped noticeably as the LIV got more distal. Statistically significant between-group differences (1-way ANOVA) were found for ROM (P < 0.001), forward flexion (P < 0.001), or backward extension (P < 0.001). The motion segments preserved significantly correlated with ROM (r = 0.76, P < 0.001), ROMF (r = 0.76, P < 0.001), and ROME (r = 0.39, P < 0.001). However, no significant between-group differences was found for each domain of SRS-22 questionnaire

  3. Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment.

    PubMed

    Upasani, Vidyadhar V; Caltoum, Christine; Petcharaporn, Maty; Bastrom, Tracey P; Pawelek, Jeff B; Betz, Randal R; Clements, David H; Lenke, Lawrence G; Lowe, Thomas G; Newton, Peter O

    2008-05-01

    A multicenter study of changes in Scoliosis Research Society (SRS) outcome measures after surgical treatment of adolescent idiopathic scoliosis (AIS). To evaluate changes in patient determined outcome measures between 2 and 5 years after AIS surgery. Current surgical procedures have been shown to improve subjective measures in patients with AIS. At 2-year follow-up, AIS patients reported significant improvement in all 4 preoperative domains of the SRS questionnaire. In addition, the major Cobb angle was shown to be negatively correlated with preoperative scores in the pain, general self-image, and general function domains. Five-year SRS scores have not been evaluated previously. A multicenter, prospectively generated database was used to obtain perioperative, radiographic, and SRS-24 outcomes data. The inclusion criteria were: a diagnosis of AIS, surgical treatment (anterior, posterior, or combined), a comprehensive set of radiographic measures, and completed preoperative, 2-year, and 5-year SRS questionnaires. Repeated measures analysis of variance was used to compare changes in patient responses for each of the 7 outcome domains. Univariate analysis of variance was used to compare the change in pain score at 5 years to the level of the lowest instrumented vertebrae and surgical approach. A correlation analysis was used to determine the association between changes in any of the radiographic variables and changes in SRS scores. The data were checked for normality and equal variances, and the level of significance was set at P < 0.01. Forty-nine patients (42 women, 7 men; 14.2 +/- 2.1 year old; 5.4 +/- 0.6 years follow-up) met the inclusion criteria for this study. Thirty-seven of 49 (76%) of these patients underwent an open or thoracoscopic anterior procedure. SRS-24 scores improved significantly in 3 of the 4 preoperative domains at the 2-year visit. At 5 years postop, a statistically significant decrease in the pain score (4.2 +/- 0.6 to 3.9 +/- 0.9, P = 0

  4. Chinese Adaptation of the Bad Sobernheim Stress Questionnaire for Patients With Adolescent Idiopathic Scoliosis Under Brace Treatment.

    PubMed

    Xu, Ximing; Wang, Fei; Yang, Mingyuan; Huang, Qikai; Chang, Yifan; Wei, Xianzhao; Bai, Yushu; Li, Ming

    2015-08-01

    Bad Sobernheim Stress Questionnaire (BSSQ)-Deformity and BSSQ-Brace are the most widely used instruments for evaluating stress levels in adolescent idiopathic scoliosis (AIS) patients under brace treatment, and good reliability and validity have been demonstrated across different cultures. Great stress has been found among many adolescents, becoming a major concern for professionals. However, no previous research has addressed the cultural adaptations and psychometric testing of BSSQ-Deformity and BSSQ-Brace in China or the stress levels in AIS patients. The purposes of our study were to evaluate the cross-cultural adaptation and validation of the BSSQ-Deformity and BSSQ-Brace and to investigate stress levels in Chinese (AIS) patients under brace treatment.The original (German) versions of BSSQ-Deformity and BSSQ-Brace were cross-culturally translated according to international guidelines. Psychometric properties such as reliability and construct validity were tested. Eighty-six AIS patients were included in our study, and 50 patients paid a second visit 3 to 7 days later to test reproducibility. Cronbach α and the intraclass coefficient were determined to assess internal consistency and reproducibility. Scoliosis Research Society patient questionnaire-22 (SRS-22) was applied to evaluate construct validity.The mean BSSQ-Deformity and BSSQ-Brace scores were 15.3 and 13.4 points, respectively. Severe stress was observed in 12% of patients due to brace treatment. Item analysis demonstrated that each item was scored under a normal distribution with no redundancy. Psychometric analysis revealed excellent internal consistency (Cronbach α = 0.85 and 0.80, respectively) and reproducibility (intraclass correlation coefficient = 0.85 and 0.90, respectively) for BSSQ-Deformity and BSSQ-Brace. The correlation coefficients of BSSQ-Deformity, BSSQ-Brace and SRS-22 were 0.48 and 0.63, respectively.In conclusion, BSSQ-Deformity and BSSQ-Brace have been successfully

  5. Chinese Adaptation of the Bad Sobernheim Stress Questionnaire for Patients With Adolescent Idiopathic Scoliosis Under Brace Treatment

    PubMed Central

    Xu, Ximing; Wang, Fei; Yang, Mingyuan; Huang, Qikai; Chang, Yifan; Wei, Xianzhao; Bai, Yushu; Li, Ming

    2015-01-01

    Abstract Bad Sobernheim Stress Questionnaire (BSSQ)-Deformity and BSSQ-Brace are the most widely used instruments for evaluating stress levels in adolescent idiopathic scoliosis (AIS) patients under brace treatment, and good reliability and validity have been demonstrated across different cultures. Great stress has been found among many adolescents, becoming a major concern for professionals. However, no previous research has addressed the cultural adaptations and psychometric testing of BSSQ-Deformity and BSSQ-Brace in China or the stress levels in AIS patients. The purposes of our study were to evaluate the cross-cultural adaptation and validation of the BSSQ-Deformity and BSSQ-Brace and to investigate stress levels in Chinese (AIS) patients under brace treatment. The original (German) versions of BSSQ-Deformity and BSSQ-Brace were cross-culturally translated according to international guidelines. Psychometric properties such as reliability and construct validity were tested. Eighty-six AIS patients were included in our study, and 50 patients paid a second visit 3 to 7 days later to test reproducibility. Cronbach α and the intraclass coefficient were determined to assess internal consistency and reproducibility. Scoliosis Research Society patient questionnaire-22 (SRS-22) was applied to evaluate construct validity. The mean BSSQ-Deformity and BSSQ-Brace scores were 15.3 and 13.4 points, respectively. Severe stress was observed in 12% of patients due to brace treatment. Item analysis demonstrated that each item was scored under a normal distribution with no redundancy. Psychometric analysis revealed excellent internal consistency (Cronbach α = 0.85 and 0.80, respectively) and reproducibility (intraclass correlation coefficient = 0.85 and 0.90, respectively) for BSSQ-Deformity and BSSQ-Brace. The correlation coefficients of BSSQ-Deformity, BSSQ-Brace and SRS-22 were 0.48 and 0.63, respectively. In conclusion, BSSQ-Deformity and BSSQ-Brace have been

  6. A Comparison of Patient-Reported Outcome Measures Following Different Treatment Approaches for Adolescents with Severe Idiopathic Scoliosis: A Systematic Review

    PubMed Central

    Weiss, Hans-Rudolf; Chockalingam, Nachiappan; Kandasamy, Gokulakannan; Arnell, Tracey

    2016-01-01

    Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine which is usually not symptomatic and which can progress during growth and cause a surface deformity. In adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Although surgery is usually recommended for curvatures exceeding 40° to 50° to stop curvature progression, recent reviews have shed some light on the long-term complications of such surgery and to the lack of evidence for such complicated procedures within the scientific literature. Furthermore, a number of patients are very fearful of having surgery and refuse this option or live in countries where specialist scoliosis surgery is not available. Other patients may be unable to afford the cost of specialist scoliosis surgery. For these patients the only choice is an alternative non-surgical treatment option. To examine the impact of different management options in patients with severe AIS, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short-term (a few months) and the long-term (over 20 years). We searched CENTRAL, MEDLINE, EMBASE, CINHAL and two other databases up to January 2016 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive hand search of the grey literature. We searched for randomised controlled trials as well as prospective and retrospective controlled trials comparing spinal fusion surgery with no treatment or conservative treatment in AIS patients with a Cobb angle greater than 40°. We did not identify any evidence of superiority of effectiveness of operative compared to nonoperative interventions for patients with severe AIS. Within the present literature there is no clear evidence to suggest that a specific type of treatment is superior to

  7. A Comparison of Patient-Reported Outcome Measures Following Different Treatment Approaches for Adolescents with Severe Idiopathic Scoliosis: A Systematic Review.

    PubMed

    Bettany-Saltikov, Josette; Weiss, Hans-Rudolf; Chockalingam, Nachiappan; Kandasamy, Gokulakannan; Arnell, Tracey

    2016-12-01

    Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine which is usually not symptomatic and which can progress during growth and cause a surface deformity. In adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Although surgery is usually recommended for curvatures exceeding 40° to 50° to stop curvature progression, recent reviews have shed some light on the long-term complications of such surgery and to the lack of evidence for such complicated procedures within the scientific literature. Furthermore, a number of patients are very fearful of having surgery and refuse this option or live in countries where specialist scoliosis surgery is not available. Other patients may be unable to afford the cost of specialist scoliosis surgery. For these patients the only choice is an alternative non-surgical treatment option. To examine the impact of different management options in patients with severe AIS, with a focus on trunk balance, progression of scoliosis, cosmetic issues, quality of life, disability, psychological issues, back pain, and adverse effects, at both the short-term (a few months) and the long-term (over 20 years). We searched CENTRAL, MEDLINE, EMBASE, CINHAL and two other databases up to January 2016 with no language limitations. We also checked the reference lists of relevant articles and conducted an extensive hand search of the grey literature. We searched for randomised controlled trials as well as prospective and retrospective controlled trials comparing spinal fusion surgery with no treatment or conservative treatment in AIS patients with a Cobb angle greater than 40°. We did not identify any evidence of superiority of effectiveness of operative compared to nonoperative interventions for patients with severe AIS. Within the present literature there is no clear evidence to suggest that a specific type of treatment is superior to

  8. [Bracing in Adolescent Idiopathic Scoliosis].

    PubMed

    Lo, Yi-Fang; Huang, Yu-Chu

    2017-04-01

    Scoliosis is a common medical problem, with an incidence of between 0.47% and 5.2% in the general population globally. Adolescent idiopathic scoliosis (AIS) accounts for nearly 80% of all scoliosis. Young people with AIS often experience negative social consequences in association with their condition. Without proper and timely treatment, the potential resulting disabilities range from trunk deformity, pain, and neurological complications to compromised cardiopulmonary function, all of which may cause lifelong suffering. Scoliosis may be treated either conservatively or surgically, based on the severity of the disease. Bracing is the most widely adopted method of conservative treatment. However, the main goal of bracing is to inhibit the progression of the spinal curvature rather than to cure scoliosis. The clinical effectiveness of bracing in Taiwan has often been underutilized as a result of financial or other factors such as the availability of the treatment. The purpose of the present review is to clarify the effectiveness of bracing for AIS by elucidating the pathophysiology of scoliosis and examining the recent clinical evidence. The importance of preventative care and the unique contribution of nursing care to treatment has to date been under-recognized. The positive support that nurses provide to the families of the patients during the early phases of treatment as well as to the patients themselves, including helping them exercise appropriately and wear the brace correctly, is an essential component of effective treatment. Learning how to work with and to adapt to the brace being part of the body is an important part of the treatment as well as a way to avoid pain. Nurses are in an ideal position to facilitate this learning process and, overall, to provide health education.

  9. Testicular parenchymal abnormalities in Klinefelter syndrome: a question of cancer? Examination of 40 consecutive patients

    PubMed Central

    Accardo, Giacomo; Vallone, Gianfranco; Esposito, Daniela; Barbato, Filomena; Renzullo, Andrea; Conzo, Giovanni; Docimo, Giovanni; Esposito, Katherine; Pasquali, Daniela

    2015-01-01

    Klinefelter syndrome (KS) is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology generally; nevertheless it seems to be low. We evaluated the need for imaging and serum tumor markers for testicular cancer screening in KS. Participants were 40 consecutive KS patients, enrolled from December 2009 to January 2013. Lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin subunit (β-HCG) serum levels assays and testicular ultrasound (US) with color Doppler, were carried out at study entry, after 6 months and every year for 3 years. Abdominal magnetic resonance (MR) was performed in KS when testicular US showed micro-calcifications, testicular nodules and cysts. Nearly 62% of the KS had regular testicular echotexture, 37.5% showed an irregular echotexture and 17.5% had micro-calcifications and cysts. Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules <1 cm, but none had nodules >1 cm. MR ruled out the diagnosis of cancer in all KS with testicular micro calcifications, nodules and cysts. No significant variations in LDH, AFP, and β-HCG levels and in US pattern have been detected during follow-up. We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found. We did not find testicular cancer in KS, and testicular US, tumor markers and MR were, in selected cases, useful tools for correctly discriminating benign from malignant lesions. PMID:25130577

  10. Testicular parenchymal abnormalities in Klinefelter syndrome: a question of cancer? Examination of 40 consecutive patients.

    PubMed

    Accardo, Giacomo; Vallone, Gianfranco; Esposito, Daniela; Barbato, Filomena; Renzullo, Andrea; Conzo, Giovanni; Docimo, Giovanni; Esposito, Katherine; Pasquali, Daniela

    2015-01-01

    Klinefelter syndrome (KS) is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology generally; nevertheless it seems to be low. We evaluated the need for imaging and serum tumor markers for testicular cancer screening in KS. Participants were 40 consecutive KS patients, enrolled from December 2009 to January 2013. Lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin subunit (β-HCG) serum levels assays and testicular ultrasound (US) with color Doppler, were carried out at study entry, after 6 months and every year for 3 years. Abdominal magnetic resonance (MR) was performed in KS when testicular US showed micro-calcifications, testicular nodules and cysts. Nearly 62% of the KS had regular testicular echotexture, 37.5% showed an irregular echotexture and 17.5% had micro-calcifications and cysts. Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules <1 cm, but none had nodules >1 cm. MR ruled out the diagnosis of cancer in all KS with testicular micro calcifications, nodules and cysts. No significant variations in LDH, AFP, and β-HCG levels and in US pattern have been detected during follow-up. We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found. We did not find testicular cancer in KS, and testicular US, tumor markers and MR were, in selected cases, useful tools for correctly discriminating benign from malignant lesions.

  11. Management of a 59-year-old female patient with adult degenerative scoliosis using manipulation under anesthesia

    PubMed Central

    Morningstar, Mark W.; Strauchman, Megan N.

    2010-01-01

    Objective Manipulation under anesthesia (MUA) is an outpatient procedure that is performed to restore normal joint kinematics and musculoskeletal function. This article presents a case of a patient with idiopathic lumbar degenerative scoliosis who developed intractable pain as an adult and reports on the outcomes following a trial of MUA. Clinical Features A 59-year-old female patient presented to a chiropractic office with primary subjective symptoms of lower back and bilateral hip pain. Numerical pain rating scores were reported at 8 of 10 for the lower back and 9 of 10 for the sacroiliac joint/gluteal region. A disability score using a functional rating index demonstrated a score of 26 of 40 (or 64% disability). Over the preceding 5 years, the patient had tried a number of conservative therapies to relieve her pain without success. Intervention and Outcome The patient was evaluated for MUA. The patient was scheduled for a serial MUA over 3 days. Numerical pain rating scores 8 weeks after the MUA were 1 of 10 for the lower back and 3 of 10 for the sacroiliac joint. Her disability rating decreased to 11 of 40 (28%). Radiological improvements were also observed. These outcomes were maintained at 6-month follow-up. Conclusion Pain, functional, and radiographic outcomes demonstrated improvements immediately following treatment for this patient. PMID:21629554

  12. Decreased osteogenic differentiation of mesenchymal stem cells and reduced bone mineral density in patients with adolescent idiopathic scoliosis.

    PubMed

    Park, Weon Wook; Suh, Kuen Tak; Kim, Jeung Il; Kim, Seong-Jang; Lee, Jung Sub

    2009-12-01

    Generalized low bone mass and osteopenia in both axial and peripheral skeletons have been reported in adolescent idiopathic scoliosis (AIS). However, the mechanism and causes of bone loss in AIS have not been identified. Therefore, this study examined the relationship between the osteogenic and adipogenic differentiation abilities of mesenchymal stem cells (MSCs) and bone mass in 19 patients with AIS and compared these with those of 16 age- and gender-matched patients with lower leg fracture. Mean lumbar spinal bone mineral density (LSBMD) in AIS patients was found to be lower than in controls (P = 0.037) and the osteogenic differentiation abilities and alkaline phosphatase activities of MSCs from patients were also found to be lower than those of controls (P = 0.0073 and P = 0.001, respectively), but the abilities of the MSCs of patients and controls to undergo adipogenic differentiation were similar. The osteogenic differentiation ability was found to be positively correlated with alkaline phosphatase activity in the AIS group. However, the osteogenic and adipogenic abilities were not found to be correlated with LSBMD in either patients or controls. These findings suggest that the decreased osteogenic differentiation ability of MSCs might be one of the possible mechanisms leading to low bone mass in AIS. However, we did not determine definite mechanisms of low bone mass in AIS. Therefore, further study with large scale will be needed to identify the mechanism involved.

  13. Significance of peak height velocity as a predictive factor for curve progression in patients with idiopathic scoliosis

    PubMed Central

    2015-01-01

    Background Much attention has been paid to peak height velocity (PHV) as a possible predictor of curve progression in patients with idiopathic scoliosis (IS). The aim of this study was to analyze the relationship between the magnitude of the Cobb angle at PHV and scoliosis progression, defined as having surgery prior to skeletal maturity in female patients with IS. Methods A retrospective review identified 56 skeletally immature female IS patients who were followed until maturity. The mean age and the mean pubertal status at the initial visit were 10 years and 24 months before menarche respectively, with a follow-up period of 5 years. They were divided into two groups: non-surgery group (NS) and surgery group (S), depending on their treatment method in use at the final follow-up visit. Surgery group was defined as an ultimately having surgery due to Cobb angle greater than 45 degrees prior to skeletal maturity regardless of conservative management. Height measurements were recorded at each visit; height velocity was calculated as the height change, in cm, divided by the time interval, in years. The PHV, chronological age at PHV (APHV), height at PHV (HPHV), and final height (FH) were determined for each group. In patients with Cobb angle greater than 30 degrees, the corrected height was calculated by Kono formula and corrected height velocity values were provided. The sensitivity, specificity, and area under the curve (AUC) of the receiver-operating -characteristic (ROC) analysis were calculated to predict spinal curve progression for various Cobb-angle cutoff values at PHV. Results The corrected PHV had a mean value of 8.5 and 8.9 cm/year in the NS-group and S-group, respectively. The APHV was 11.9 and 11 years, the corrected HPHV was 152.9, and 149.3 cm, and the corrected FH was 159.9 and 159.3 cm, respectively. When a Cobb angle of 31.5 degrees was at PHV, ROC analysis revealed 78% sensitivity, 82% specificity, and an AUC of 0.93, acceptable values for curve

  14. Predictors of allogeneic blood transfusion in spinal fusion for pediatric patients with idiopathic scoliosis in the United States, 2004-2009.

    PubMed

    Yoshihara, Hiroyuki; Yoneoka, Daisuke

    2014-10-15

    Analysis of population-based National Hospital Discharge Survey data collected for the Nationwide Inpatient Sample. To examine the predictors of allogeneic blood transfusion (ALBT) in spinal fusion for pediatric patients with idiopathic scoliosis. Spinal fusion for pediatric patients with idiopathic scoliosis is associated with major blood loss and often necessitates ALBT. The Nationwide Inpatient Sample was used to identify pediatric patients with idiopathic scoliosis who underwent spinal fusion from 2004 to 2009, using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Then, patients who received ALBT were identified using the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification code. Patient demographics, surgical variables, and hospital characteristics were retrieved. Multivariate logistic regression analysis was performed to identify the predictors of ALBT in spinal fusion for pediatric patients with idiopathic scoliosis. The odds ratio (OR) increased with increasing Elixhauser Comorbidity Score (score 1: OR, 1.55; 95% confidence interval [95% CI], 1.23-1.97; score 2: OR, 2.23; 95% CI, 1.69-2.93; score 3: OR, 2.73; 95% CI, 1.6-4.66; score≥4: OR, 4.18; 95% CI, 1.93-9.06). Patients who underwent posterior approach or anterior and posterior approach surgical procedures were more likely to receive ALBT compared with those who underwent anterior approach surgery (posterior: OR, 2.24; 95% CI, 1.22-4.08; anterior and posterior: OR, 3.35; 95% CI, 1.69-6.63). Patients with a spinal fusion of 9 or more levels were more likely to receive ALBT compared with those with a spinal fusion of 4 to 8 levels (OR, 1.39; 95% CI, 1.05-1.85). There was no difference between patients with or without autologous-related blood transfusion (OR, 0.92; 95% CI, 0.59-1.43). This study identified significant predictors of ALBT in spinal fusion for pediatric patients with idiopathic scoliosis. These factors need to

  15. Beneficial effects of aerobic training in adolescent patients with moderate idiopathic scoliosis.

    PubMed

    Bas, Paloma; Romagnoli, Marco; Gomez-Cabrera, Mari-Carmen; Bas, Jose Luis; Aura, Javier Villar; Franco, Nuria; Bas, Teresa

    2011-08-01

    The major aim of this study was to determine whether after 6 weeks of aerobic training adolescent idiopathic scoliosis (AIS) girls who suffer from mild scoliotic curvatures (n = 6) behaved in a similar way than healthy controls (n = 6) in different biochemical, anthropometric, and cardio respiratory parameters. The maximal power output and the power output achieved at the anaerobic threshold (AT), during the maximal exercise test, were significantly increased in both experimental groups, when compared with resting conditions. The training program caused significant changes in body composition (i.e., a decrease in body fat %) only in the scoliotic group. Regarding the cardio respiratory measurements, VO(2max) was increased by 17% in AIS group and 10% in the healthy group. Our results suggest that physical activity should be encouraged in scoliotic girls with mild curvatures.

  16. Effect of the Schroth method of emphasis of active holding on Cobb’s angle in patients with scoliosis: a case report

    PubMed Central

    Lee, Hyung Joo; Seong, Hwa Dong; Bae, Young-Hyeon; Jang, Ho-Young; Chae, Seung Hun; Kim, Kyoung Hoon; Lee, Suk Min

    2016-01-01

    [Purpose] The purpose of this study was to examine the effect of the Schroth method (three-dimensional convergence exercise) of emphasis of active holding on pain and Cobb’s angle in patients with scoliosis. [Subjects and Methods] It applied the Schroth method program of emphasis of active holding individually to three subjects three time per week for 15 weeks. All subject were measured Cobb’s angle and pain. [Results] After 15 weeks, pain and Cobb’s angle decreased compared to values before. [Conclusion] These results demonstrate the benefit of the Schroth exercise program of emphasis of active holding on decreasing pain and Cobb’s angle in patients with idiopathic scoliosis. PMID:27821972

  17. A new corrective technique for adolescent idiopathic scoliosis (Ucar's convex rod rotation).

    PubMed

    Uçar, Bekir Yavuz

    2014-07-01

    Prospective single-center study. To analyze the efficacy and safety of a new technique of global vertebral correction with convex rod rotation performed on the patients with adolescent idiopathic scoliosis. Surgical goal is to obtain an optimal curve correction in scoliosis surgery. There are various correction techniques. This report describes a new technique of global vertebral correction with convex rod rotation. A total of 12 consecutive patients with Lenke type I adolescent idiopathic scoliosis and managed by convex rod rotation technique between years 2012 and 2013 having more than 1 year follow-up were included. Mean age was 14.5 (range = 13-17 years) years at the time of operation. The hospital charts were reviewed for demographic data. Measurements of curve magnitude and balance were made on 36-inch standing anteroposterior and lateral radiographs taken before surgery and at most recent follow up to assess deformity correction, spinal balance, and complications related to the instrumentation. Preoperative coronal plane major curve of 62° (range = 50°-72°) with flexibility of less than 30% was corrected to 11.5°(range = 10°-14°) showing a 81% scoliosis correction at the final follow-up. Coronal imbalance was improved 72% at the most recent follow-up assessment. No complications were found. The new technique of global vertebral correction with Ucar's convex rod rotation is an effective technique. This method is a vertebral rotation procedure from convex side and it allows to put screws easily to the concave side.

  18. The effect of simple local resection on pain and scoliotic curve in patients with scoliosis secondary to osteoid osteoma and osteoblastoma in the spine.

    PubMed

    Balioğlu, Mehmet Bülent; Albayrak, Akif; Atıcı, Yunus; Sökücü, Sami; Tacal, Mehmet Temel; Kaygusuz, Mehmet Akif

    2016-01-01

    The aim of this study was assess the results of local resection without instrumentation in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma. The review of our database revealed 176 cases of osteoid osteomas and 18 of osteoblastomas. Painful scoliosis was seen in 5 out of 6 cases. The lesion was found on the posterior part of the apical vertebra in the concave side of the scoliotic curve. Surgical treatment consisted of simple en bloc excision. Mean period between diagnosis and operation was 2.6 years, mean age at the time of surgery was 12.5 years, and mean preoperative major Cobb angle was 37.2°. Four patients with a mean follow-up of 4.3 years were included in the study. At final follow-up, Cobb angle was 7.6°, and the average percentage of correction was 79.6%. Coronal decompensation was corrected by 87.7%. Pelvic tilt and shoulder imbalance were corrected by 15% and 74.5%, respectively. The preoperative mean Visual Analog Scale score was 9 before the treatment and 0 at the final follow-up. Our results suggested that simple en bloc resection may be a safe and effective treatment option in patients with scoliosis secondary to spinal osteoid osteoma and osteoblastoma, if patient less than 16 years, with major Cobb angle less than 40°, and duration of complaint less than 22 months.

  19. Clinical outcomes of early gastric cancer patients after noncurative endoscopic submucosal dissection in a large consecutive patient series.

    PubMed

    Suzuki, Haruhisa; Oda, Ichiro; Abe, Seiichiro; Sekiguchi, Masau; Nonaka, Satoru; Yoshinaga, Shigetaka; Saito, Yutaka; Fukagawa, Takeo; Katai, Hitoshi

    2017-07-01

    Clinical outcomes of early gastric cancer (EGC) patients after noncurative endoscopic submucosal dissection (ESD) have not been fully elucidated; we therefore aimed to clarify these outcomes. A total of 3058 consecutive patients with 3474 clinically diagnosed EGCs at initial onset underwent ESD with curative intent at our hospital between 1999 and 2010. We retrospectively assessed the following clinical outcomes of noncurative gastric ESD patients with a possible risk of lymph node (LN) metastasis by dividing patients into two groups with different treatment strategies (additional gastrectomy and simple follow-up): presence of LN metastasis at the time of gastrectomy, incidence of LN and distant metastases during the follow-up period, clinicopathological factors associated with metastasis, and 5-year disease-specific survival (DSS). After exclusion of 75 noncurative ESD patients with only a positive horizontal margin, 569 noncurative ESD patients with a possible risk of LN metastasis were identified. Among the 356 patients undergoing additional gastrectomy, LN metastasis was identified in 18 patients. A positive vertical margin with submucosal invasion (odds ratio 3.6) and lymphovascular invasion (odds ratio 3.5) were significantly associated with LN metastasis. The 5-year DSS rate was 98.8 %. Among the 212 patients who underwent simple follow-up, LN and/or distant metastases were found in eight patients. In this group, lymphovascular invasion (hazard ratio 6.6) was significantly associated with metastasis with a 5-year DSS rate of 96.8 %. Additional gastrectomy should be performed particularly in noncurative gastric ESD patients with lymphovascular invasion or a positive vertical margin with submucosal invasion.

  20. Kinematics of the chest cage and spine during breathing in healthy individuals and in patients with adolescent idiopathic scoliosis.

    PubMed

    Leong, J C; Lu, W W; Luk, K D; Karlberg, E M

    1999-07-01

    The lung function test by a Plethysmograph enabled calculations to be made of the total lung capacity and vital capacity. A Motion Analysis System (Elite, BTS Inc., Milano, Italy) was used to observe and record chest cage and spinal movements and as to correlate lung function with the chest cage and spine kinematics. To determine the three-dimensional kinematics and the shape and size changes of the chest cage and thoracic spine motion during deep breathing in healthy and scoliotic individuals. Lateral flexion plus rotation of the involved vertebrae around a vertical axis causing a decrease in lung function is the main disfigurement of scoliosis. Reports show that even after spinal fusion, reduced vital capacity associated with an increased residual volume are detected. Factors such as angle of scoliosis, length of the spinal column involved, and duration of the deformity influence pulmonary function but do not significantly affect its reduction. Mechanical inefficiency during breathing has not been studied. Three-dimensional kinematics of the chest cage and spine during breathing were studied in 41 scoliotic patients and in 20 healthy individuals. Three-dimensional chest cage motions relative to the spine and thoracic spine motions relative to T12 were calculated. To examine stiffness of the spine, lateral bending angles were calculated. The lung function test, which including spirometry and lung subdivision, also was performed for the scoliotic patients. Significant differences (P < 0.05) were found in the movements of the upper level of the chest cage in anteroposterior and vertical directions, ranging from 16.7 to 28.6 mm in healthy individuals and from 12.1 to 24.2 mm in scoliotic patients. The thoracic spine displayed two-dimensional movements posteriorly and vertically during breathing, whereas less movement was seen in scoliotic patients. In addition, overall the scoliotic spine showed signs of stiffness in lateral bending. The range of movement of the

  1. Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients.

    PubMed Central

    Lieberman, D.; Schlaeffer, F.; Boldur, I.; Lieberman, D.; Horowitz, S.; Friedman, M. G.; Leiononen, M.; Horovitz, O.; Manor, E.; Porath, A.

    1996-01-01

    BACKGROUND: The purpose of this study was to assess the causes of community-acquired pneumonia in adult patients admitted to hospital. METHODS: A prospective study was performed on 346 consecutive adult patients (54% men) of mean (SD) 49.3 (19.5) years (range 17-94) admitted to a university affiliated regional hospital in southern Israel with community-acquired pneumonia over a period of one year. Convalescent serum samples were obtained from 308 patients (89%). The aetiological diagnosis for community-acquired pneumonia was based on positive blood cultures and/or significant changes in antibody titres to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, respiratory viruses, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella sp. RESULTS: The aetiology of community-acquired pneumonia was identified in 279 patients (80.6%). The distribution of causal agents was as follows: S pneumoniae, 148 patients (42.8%); M pneumoniae, 101 (29.2%); C pneumoniae, 62 (17.9%); Legionella sp, 56 (16.2%); respiratory viruses, 35 (10.1%); C burnetii, 20 (5.8%); H influenzae 19 (5.5%); and other causes, 21 patients (6.0%). In patients above the age of 55 years C pneumoniae was the second most frequent aetiological agent (25.5%). In 133 patients (38.4%) more than one causal agent was found. CONCLUSIONS: The causal agents for community-acquired pneumonia in Israel are different from those described in other parts of the world. In many of the patients more than one causal agent was found. In all these patients treatment should include a macrolide antibiotic, at least in the first stage of their illness. PMID:8711652

  2. Invasive aspergillosis caused by cryptic Aspergillus species: a report of two consecutive episodes in a patient with leukaemia.

    PubMed

    Peláez, Teresa; Alvarez-Pérez, Sergio; Mellado, Emilia; Serrano, David; Valerio, Maricela; Blanco, José L; Garcia, Marta E; Muñoz, Patricia; Cuenca-Estrella, Manuel; Bouza, Emilio

    2013-03-01

    We report a case of two consecutive episodes of invasive aspergillosis caused by cryptic Aspergillus species in a patient with leukaemia. A first episode of pulmonary infection was caused by Aspergillus calidoustus and Aspergillus novofumigatus, and the second episode by A. novofumigatus and Aspergillus viridinutans. Fungal isolates were identified to species level using traditional and sequencing-based molecular methods.

  3. Quantitative analysis of a spinal surgeon's learning curve for scoliosis surgery.

    PubMed

    Ryu, K J; Suh, S W; Kim, H W; Lee, D H; Yoon, Y; Hwang, J H

    2016-05-01

    The aim of this study was a quantitative analysis of a surgeon's learning curve for scoliosis surgery and the relationship between the surgeon's experience and post-operative outcomes, which has not been previously well described. We have investigated the operating time as a function of the number of patients to determine a specific pattern; we analysed factors affecting the operating time and compared intra- and post-operative outcomes. We analysed 47 consecutive patients undergoing scoliosis surgery performed by a single, non-trained scoliosis surgeon. Operating time was recorded for each of the four parts of the procedures: dissection, placement of pedicle screws, reduction of the deformity and wound closure. The median operating time was 310 minutes (interquartile range 277.5 to 432.5). The pattern showed a continuous decreasing trend in operating time until the patient number reached 23 to 25, after which it stabilised with fewer patient-dependent changes. The operating time was more affected by the patient number (r =- 0.75) than the number of levels fused (r = 0.59). Blood loss (p = 0.016) and length of stay in hospital (p = 0.012) were significantly less after the operating time stabilised. Post-operative functional outcome scores and the rate of complications showed no significant differences. We describe a detailed learning curve for scoliosis surgery based on a single surgeon's practise, providing useful information for novice scoliosis surgeons and for those responsible for training in spinal surgery. Cite this article: Bone Joint J 2016;98-B:679-85. ©2016 The British Editorial Society of Bone & Joint Surgery.

  4. A correlation study between in-brace correction, compliance to spinal orthosis and health-related quality of life of patients with Adolescent Idiopathic Scoliosis

    PubMed Central

    2014-01-01

    Background It has been proposed that in-brace correction is the best guideline for prediction of the results of brace treatment for patients with Adolescent Idiopathic Scoliosis (AIS). However, bracing may be a stressful experience for patients and bracing non-compliance could be psychologically related. The purpose of this study was to assess the correlation between brace compliance, in-brace correction and QoL of patients with AIS. Methods Fifty-five patients with a diagnosis of AIS were recruited. All were female and aged 10 years or above when a brace was prescribed, none had undergone prior treatment, and all had a Risser sign of 0–2 and a Cobb angle of 25-40°. The patients were examined in three consecutive visits with 4 to 6 months between each visit. The Chinese translated Trunk Appearance Perception Scale (TAPS), the Chinese translated Brace Questionnaires (BrQ) and the Chinese translated SRS-22 Questionnaires were used in the study. The in-brace Cobb angle, vertebral rotation and trunk listing were also measured. Patients’ compliance, in-brace correction and patients’ QoL were assessed. To identify the relationship among these three areas, logistic regression model and generalized linear model were used. Result For the compliance measure, a significant difference (p = 0.008) was detected on TAPS mean score difference between Visit 1 and Visit 2 in the least compliant group (0–8 hours) and the most compliant group (17–23 hours). In addition, a significant difference (p = 0.000) was detected on BrQ mean score difference between Visit 2 and Visit 3 in the least compliant group (0–8 hours) and the most compliant group (17–23 hours). For the orthosis effectiveness measure, no significant difference was detected between the three groups of bracing hours (0–8 hours, 9–16 hours, 17–23 hours) on in-brace correction (below 40% and 40% or above). For the QoL measure, no significant difference was detected between the two

  5. A new brace treatment similar for adolescent scoliosis and kyphosis based on restoration of thoracolumbar lordosis. Radiological and subjective clinical results after at least one year of treatment

    PubMed Central

    2012-01-01

    Study design A prospective treatment study with a new brace was conducted Objective. To evaluate radiological and subjective clinical results after one year conservative brace treatment with pressure onto lordosis at the thoracolumbar joint in children with scoliosis and kyphosis. Summary of background data Conservative brace treatment of adolescent scoliosis is not proven to be effective in terms of lasting correction. Conservative treatment in kyphotic deformities may lead to satisfactory correction. None of the brace or casting techniques is based on sagittal forces only applied at the thoracolumbar spine (TLI= thoracolumbar lordotic intervention). Previously we showed in patients with scoliosis after forced lordosis at the thoracolumbar spine a radiological instantaneous reduction in both coronal curves of double major scoliosis. Methods A consecutive series of 91 children with adolescent scoliosis and kyphosis were treated with a modified symmetric 30 degrees Boston brace to ensure only forced lordosis at the thoracolumbar spine. Scoliosis was defined with a Cobb angle of at least one of the curves [greater than or equal to] 25 degrees and kyphosis with or without a curve <25 degrees in the coronal plane. Standing radiographs were made i) at start, ii) in brace at beginning and iii) after one year treatment without brace. Results Before treatment start ‘in brace’ radiographs showed a strong reduction of the Cobb angles in different curves in kyphosis and scoliosis groups (sagittal n = 5 all p < 0.001, pelvic obliquity p < 0.001). After one year of brace treatment in scoliosis and kyphosis group the measurements on radiographs made without brace revealed an improvement in 3 Cobb angles each. Conclusion Conservative treatment using thoracolumbar lordotic intervention in scoliotic and kyphotic deformities in adolescence demonstrates a marked improvement after one year also in clinical and postural criteria. An effect not obtained with current brace techniques

  6. Body image in idiopathic scoliosis: a comparison study of psychometric properties between four patient-reported outcome instruments.

    PubMed

    Matamalas, Antonia; Bagó, Joan; D'Agata, Elisabetta; Pellisé, Ferran

    2014-06-03

    Four patient-reported outcome (PRO) instruments are commonly used to assess body image in idiopathic scoliosis (IS): the Quality of Life Profile for Spinal Deformities (QLPSD), SRS-22 Self-Image scale, Spinal Appearance Questionnaire (SAQ), and Trunk Appearance Perception Scale (TAPS). The aim of this study is to compare the psychometric properties of these instruments in patients with IS and report the translational/cultural adaptation of the SAQ to Spanish. The four instruments in a Spanish version were administered to 80 patients with IS aged 10 to 40 years old. The sample was stratified according to scoliosis magnitude (less and more than 45º). Analysis was also conducted for age groups. The psychometric properties studied included convergent and divergent construct validity, as well as internal consistency. Convergent validity was evaluated by correlation analysis between the self-image instruments and Cobb angle. Divergent validity was assessed with correlation analysis between PRO scores and SRS-22 dimensions scores such as Function, Pain and Mental Health. In the overall sample, each of the PRO instruments demonstrated high internal consistency (QLPSD Body Image, α = 0.80; SRS-22 Self Image, α = 0.78; SAQ, α = 0.89; TAPS, α = 0.87), also both for younger and adult patients subgroups. Correlation with curve magnitude was significant for each of the four scales. However, the correlation was higher for the pictorial scales (SAQ Appearance r = 0.61, TAPS r = -0.62) than for the textual scales (QLPSD-bi r = 0.36, SRS-22 Self-Image scale r = -0.41). In the younger group, correlation between Cobb angle and textual scales (QLPSD-bi and SRS-22 Self-Image Scale) was not significant. Body Image scales showed significant correlations with SRS-22 Pain, Function and Mental Health dimensions. All four instruments tested have good psychometric properties. Pictorial scales (SAQ Appearance and TAPS) correlated better with the radiological

  7. Development of an online information and support resource for adolescent idiopathic scoliosis patients considering surgery: perspectives of health care providers

    PubMed Central

    2010-01-01

    Background Adolescents with idiopathic scoliosis who are considering spinal surgery face a major decision that requires access to in-depth information and support. Unfortunately, most online resources provide incomplete and inconsistent information and minimal social support. The aim of this study was to develop an online information and support resource for adolescent idiopathic scoliosis (AIS) patients considering spinal surgery. Prior to website development, a user-based needs assessment was conducted. The needs assessment involved a total of six focus groups with three stakeholder groups: (1) post-operative AIS patients or surgical candidates (10-18 years) (n = 11), (2) their parents (n = 6) and (3) health care providers (n = 11). This paper reports on the findings from focus groups with health care providers. Methods Focus group methodology was used to invite a range of perspectives and stimulate discussion. During audio-recorded focus groups, an emergent table of website content was presented to participants for assessment of relevance, viability and comprehensiveness in targeting global domains of need. Specifically, effective presentation of content, desired aspects of information and support, and discussions about the value of peer support and the role of health professionals were addressed. Focus group transcripts were then subject to content analysis through a constant comparative review and analysis. Results Two focus groups were held with health care providers, consisting of 5 and 6 members respectively. Clinicians provided their perceptions of the information and support needs of surgical patients and their families and how this information and support should be delivered using internet technology. Health care providers proposed four key suggestions to consider in the development of this online resource: (1) create the website with the target audience in mind; (2) clearly state the purpose of the website and organize website content to support the

  8. Development of an online information and support resource for adolescent idiopathic scoliosis patients considering surgery: perspectives of health care providers.

    PubMed

    Macculloch, Radha; Nyhof-Young, Joyce; Nicholas, David; Donaldson, Sandra; Wright, James G

    2010-06-29

    Adolescents with idiopathic scoliosis who are considering spinal surgery face a major decision that requires access to in-depth information and support. Unfortunately, most online resources provide incomplete and inconsistent information and minimal social support. The aim of this study was to develop an online information and support resource for adolescent idiopathic scoliosis (AIS) patients considering spinal surgery. Prior to website development, a user-based needs assessment was conducted. The needs assessment involved a total of six focus groups with three stakeholder groups: (1) post-operative AIS patients or surgical candidates (10-18 years) (n = 11), (2) their parents (n = 6) and (3) health care providers (n = 11). This paper reports on the findings from focus groups with health care providers. Focus group methodology was used to invite a range of perspectives and stimulate discussion. During audio-recorded focus groups, an emergent table of website content was presented to participants for assessment of relevance, viability and comprehensiveness in targeting global domains of need. Specifically, effective presentation of content, desired aspects of information and support, and discussions about the value of peer support and the role of health professionals were addressed. Focus group transcripts were then subject to content analysis through a constant comparative review and analysis. Two focus groups were held with health care providers, consisting of 5 and 6 members respectively. Clinicians provided their perceptions of the information and support needs of surgical patients and their families and how this information and support should be delivered using internet technology. Health care providers proposed four key suggestions to consider in the development of this online resource: (1) create the website with the target audience in mind; (2) clearly state the purpose of the website and organize website content to support the user; (3) offer a

  9. Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation.

    PubMed

    Benli, I Teoman; Ates, Bülent; Akalin, Serdar; Citak, Mehmet; Kaya, Alper; Alanay, Ahmet

    2007-03-01

    Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4+/-1.9 and mean follow-up period was 136.9+/-12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8 degrees +/-17.5 degrees . Major curves that were corrected by 38.7+/-22.1% in the bending radiograms, postoperatively achieved a correction of 64.0+/-15.8%. At the last follow-up visit, 10.3 degrees +/-10.8 degrees of correction loss was recorded in major curves in the frontal plane with 50.5+/-23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7 degrees +/-7.4 degrees , 37.0 degrees +/-8.4 degrees , 37.5 degrees +/-8.7 degrees , and 36.3 degrees +/-8.5 degrees , respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9 degrees and 12.9 degrees for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively

  10. Spinal Fusion for Scoliosis in Rett Syndrome With an Emphasis on Respiratory Failure and Opioid Usage.

    PubMed

    Rumbak, Dania M; Mowrey, Wenzhu; W Schwartz, Skai; Sarwahi, Vishal; Djukic, Aleksandra; Killinger, James S; Katyal, Chhavi

    2016-02-01

    Our objective was to characterize our experience with 8 patients with Rett syndrome undergoing scoliosis surgery in regard to rates of respiratory failure and rates of ventilator-acquired pneumonia in comparison to patients with neurologic scoliosis and adolescent idiopathic scoliosis. This study was a retrospective chart review of patients undergoing scoliosis surgery at a tertiary children's hospital. Patients were divided into 3 groups: (1) adolescent idiopathic scoliosis, (2) neurologic scoliosis, and (3) Rett syndrome. There were 133 patients with adolescent idiopathic scoliosis, 48 patients with neurologic scoliosis, and 8 patients with Rett syndrome. We found that patients with Rett syndrome undergoing scoliosis surgery have higher rates of respiratory failure and longer ventilation times in the postoperative period when compared with both adolescent idiopathic scoliosis and neurologic scoliosis patients. There is insufficient evidence to suggest a difference in the incidence of ventilator-acquired pneumonia between the Rett syndrome and the neurologic scoliosis group. We believe our findings are the first in the literature to show a statistically significant difference between these 3 groups in regard to incidence of respiratory failure.

  11. Effects of the Schroth exercise on the Cobb’s angle and vital capacity of patients with idiopathic scoliosis that is an operative indication

    PubMed Central

    Kim, Kyoung-Don; Hwangbo, Pil-Neo

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of the Schroth exercise on the Cobb’s angle and vital capacity of patients with growing idiopathic scoliosis, an operative indication. [Subjects] Five idiopathic scoliosis patients with a Cobb’s angle of the thoracic vertebra of 40 degrees or higher and Risser sign stage 3 or higher. [Methods] The Schroth exercise was applied 3 times a week for 12 weeks. We measured the thoracic trunk inclination, Cobb’s angle, and vital capacity before and after the exercise program. [Results] The thoracic trunk rotation angle decreased from 11.86 ± 3.32° to 4.90 ± 1.91° on average, the thoracic Cobb’s angle decreased from 42.40 ± 7.86° to 26.0 ± 3.65° on average, and the vital capacity also increased from 2.83 ± 1.23° to 4.04° ± 1.67° on average. All these effects were significant. [Conclusion] The 12-week Schroth exercise caused significant effects in the thoracic trunk inclination, Cobb’s angle, and vital capacity. The conservative treatment method was found to be effective even at a 40 degree or higher Cobb’s angle. In the future, universal exercise approach methods and preventive training for the treatment of scoliosis should be developed further. PMID:27134385

  12. Effects of the Schroth exercise on the Cobb's angle and vital capacity of patients with idiopathic scoliosis that is an operative indication.

    PubMed

    Kim, Kyoung-Don; Hwangbo, Pil-Neo

    2016-03-01

    [Purpose] The purpose of this study was to investigate the effects of the Schroth exercise on the Cobb's angle and vital capacity of patients with growing idiopathic scoliosis, an operative indication. [Subjects] Five idiopathic scoliosis patients with a Cobb's angle of the thoracic vertebra of 40 degrees or higher and Risser sign stage 3 or higher. [Methods] The Schroth exercise was applied 3 times a week for 12 weeks. We measured the thoracic trunk inclination, Cobb's angle, and vital capacity before and after the exercise program. [Results] The thoracic trunk rotation angle decreased from 11.86 ± 3.32° to 4.90 ± 1.91° on average, the thoracic Cobb's angle decreased from 42.40 ± 7.86° to 26.0 ± 3.65° on average, and the vital capacity also increased from 2.83 ± 1.23° to 4.04° ± 1.67° on average. All these effects were significant. [Conclusion] The 12-week Schroth exercise caused significant effects in the thoracic trunk inclination, Cobb's angle, and vital capacity. The conservative treatment method was found to be effective even at a 40 degree or higher Cobb's angle. In the future, universal exercise approach methods and preventive training for the treatment of scoliosis should be developed further.

  13. Scoliosis secondary to lumbar osteoid osteoma

    PubMed Central

    Zhang, Haiping; Niu, Xingbang; Wang, Biao; He, Simin; Hao, Dingjun

    2016-01-01

    Abstract Rationale: Lumbar osteoid osteoma has a low incidence, which could easily lead to scoliosis. Patient concerns: Scoliosis secondary to lumbar osteoid osteoma could be easily misdiagnosed when patients do not complain of obvious symptoms. Diagnoses: We reported a case of a 9-year-old boy with back deformity that was firstly diagnosed with scoliosis at the local hospital. After prescribed with orthosis, the patient experienced aggravating pain that could not be relieved with painkillers. After he admitted to our hospital for further medical advice, he was prescribed to complete radiological examinations. Considering his radiological examination results and his medical history, correct diagnosis of lumbar osteoid osteoma was made. Interventions: Surgical intervention of posterior lesion resection was conducted after diagnosis. Intra-operative frozen pathology indicated features of osteoid osteoma. As the lesion involved inferior articular process of L5, which could cause lumbar instability after lesion resection, internal fixation was conducted at L4-S1 segment, and posterolateral bone fusion was also conducted at L5-S1 segment. Outcomes: Three months after operation, the patient showed marked improvement of scoliosis deformity and great relief of lumbar pain. Lessons subsections: Although spine osteoid osteoma is clinically rare, it shall not be overlooked when young patients present with scoliosis first. Radiological results including computed tomography and magnetic resonance imaging shall be taken carefully as reference when making diagnosis. Surgical intervention of lesion resection could well improve scoliosis and relieve lumbar pain. PMID:27893671

  14. Early onset scoliosis: the value of serial risser casts.

    PubMed

    Waldron, Sean R; Poe-Kochert, Connie; Son-Hing, Jochen P; Thompson, George H

    2013-12-01

    Treatment of early onset scoliosis (EOS) is challenging. In many cases, bracing will not be effective and growing rod surgery may be inappropriate. Serial, Risser casts may be an effective intermediate method of treatment. We studied 20 consecutive patients with EOS who received serial Risser casts under general anesthesia between 1999 and 2011. Analyses included diagnosis, sex, age at initial cast application, major curve severity, initial curve correction, curve magnitude at the time of treatment change or latest follow-up for those still in casts, number of casts per patient, the type of subsequent treatment, and any complications. There were 8 patients with idiopathic scoliosis, 6 patients with neuromuscular scoliosis, 5 patients with syndromic scoliosis, and 1 patient with skeletal dysplasia. Fifteen patients were female and 5 were male. The mean age at first cast was 3.8±2.3 years (range, 1 to 8 y), and the mean major curve magnitude was 74±18 degrees (range, 40 to 118 degrees). After initial cast application, the major curve measured 46±14 degrees (range, 25 to 79 degrees). At treatment change or latest follow-up for those still in casts, the major curve measured 53±24 degrees (range, 13 to 112 degrees). The mean time in casts was 16.9±9.1 months (range, 4 to 35 mo). The mean number of casts per patient was 4.7±2.2 casts (range, 1 to 9 casts). At the time of this study, 7 patients had undergone growing rod surgery, 6 patients were still undergoing casting, 5 returned to bracing, and 2 have been lost to follow-up. Four patients had minor complications: 2 patients each with superficial skin irritation and cast intolerance. Serial Risser casting is a safe and effective intermediate treatment for EOS. It can stabilize relatively large curves in young children and allows the child to reach a more suitable age for other forms of treatment, such as growing rods. Level IV; case series.

  15. Differences in postoperative quality of life between adolescent patients with idiopathic scoliosis residing in urban and rural environments.

    PubMed

    Wang, Chuanfeng; Xu, Weidong; He, Shisheng; Gu, Suxi; Zhao, Yingchuan; Zhang, Jingtao; Zhu, Xiaodong; Li, Ming

    2010-03-15

    A prospective cross-sectional study. To study the effects of living environment, rural and urban, on the postoperative quality of life in adolescent patients with idiopathic scoliosis (AIS) and to explore its causes. Many factors are capable of influencing the health-related quality of life of AIS patients including degree of the malformation, culture, treatment method, and the living environment of the patient. Postoperative AIS patients (n = 117, 16 males and 101 females) were divided into 2 groups (the urban group and the rural group). All patients completed the simplified Chinese version of the SRS-22 scale and the scores on the individual domain, and items were compared between the 2 groups. The score on satisfaction of management domain in the urban group was higher than that in the rural group, but the score on the self-image/appearance in the urban group was significantly lower (P < 0.05). There were no significant differences in function/activity, pain or mental health domain between the 2 groups (P > 0.05). Scores for items 12, 15, and 18 in the function/activity domain, items 4, 6, and 10 in the self-image/appearance domain, and item 22 in the satisfaction of management domain were significantly different between the 2 groups (P < 0.05). Living environment may influence the assessment results of the postoperative quality of life in AIS patients. The effects of environment (i.e., rural vs. urban) should be considered when using the SRS-22 scale to evaluate the quality of life of the patients.

  16. Disproportionate growth between the spine and pelvis in patients with thoracic adolescent scoliosis: a new look into the pattern's growth.

    PubMed

    Bao, H; Liu, Z; Yan, P; Qiu, Y; Zhu, F

    2015-12-01

    A self-control ratio, the spine-pelvis index (SPI), was proposed for the assessment of patients with adolescent idiopathic scoliosis (AIS) in this study. The aim was to evaluate the disproportionate growth between the spine and pelvis in these patients using SPI. A total of 64 female patients with thoracic AIS were randomly enrolled between December 2010 and October 2012 (mean age 13 years, standard deviation (sd) 2.17; 9 to 18) and a further 73 healthy female patients with a mean age of 12.4 years (mean age 12.4 years, sd 2.24; 9 to 18), were randomly selected from a normal control database at our centre. The radiographic parameters measured included length of spine (LOS), height of spine (HOS), length of thoracic vertebrae (LOT), height of thoracic vertebrae (HOT), width of pelvis (WOP), height of pelvis (HOP) and width of thorax (WOT). SPI was defined as the ratio LOS/HOP. The SPI and LOT/HOP in patients with AIS showed a significant increase when compared with normal girls (p < 0.001 and p < 0.001 respectively), implying an abnormal pattern of growth of the spine relative to the pelvis in patients with AIS. No significant difference in SPI was found in different age groups in the control group, making the SPI an age-independent parameter with a mean value of 2.219 (2.164 to 2.239). We also found that the SPI was not related to maturity in the control group. This study, for the first time, used a self-control ratio to confirm the disproportionate patterns of growth of the spine and pelvis in patients with thoracic AIS, highlighting that the SPI is not affected by age or maturity.

  17. Anterior spinal fusion for thoracolumbar scoliosis: comprehensive assessment of radiographic, clinical, and pulmonary outcomes on 2-years follow-up.

    PubMed

    Verma, Kushagra; Auerbach, Joshua D; Kean, Kristin E; Chamas, Firas; Vorsanger, Matthew; Lonner, Baron S

    2010-01-01

    There is a continued role for anterior spinal fusion (ASF) in the treatment of thoracolumbar scoliosis. Despite numerous previous reports of ASF in the treatment of thoracolumbar scoliosis, no single study has simultaneously evaluated clinical, radiographic, and pulmonary function outcomes. Retrospective review of 31 consecutive thoracolumbar adolescent idiopathic scoliosis patients (Lenke type 5) who underwent ASF by a single surgeon. Patient records were comprehensively assessed for Scoliosis Research Society (SRS)-22 score, apical trunk rotation, radiographic changes, and pulmonary function before surgery and at 2-years follow-up. Thoracolumbar/lumbar curve correction averaged from 45 to 11 degrees (74%) and spontaneous correction of thoracic curves averaged from 26 to 15 degrees (42%). Instrumented segment lordosis increased by 11 degrees, whereas proximal junction kyphosis increased by 3 degrees. No significant changes were noted in T2-T12 kyphosis, distal junctional kyphosis, T12-S1 lumbar lordosis, or coronal balance. Thoracolumbar apical trunk rotation improved from 12 to 3 degrees. Average SRS scores significantly improved from 3.9 to 4.4. SRS assessments of self-image and pain also improved significantly from 3.6 to 4.5 and from 4.1 to 4.6, respectively. Absolute and percent predicted forced vital capacity and forced expiratory volume in 1 second were unchanged. Two patients suffered mild intercostal neuralgia postthoracotomy. There were no other complications. The thoracoabdominal anterior approach for thoracolumbar scoliosis facilitates excellent clinical and radiographic outcomes, minimal blood loss, powerful apical trunk rotation correction, relative maintenance of lordosis, relatively short fusion constructs, and improved SRS-22 performance, without significant pulmonary function impairment at 2 years. It continues to be an efficacious treatment for thoracolumbar scoliosis. Level IV.

  18. Spot14/Spot14R expression may be involved in MSC adipogenic differentiation in patients with adolescent idiopathic scoliosis

    PubMed Central

    WANG, QIFEI; YANG, JUNLIN; LIN, XIANG; HUANG, ZIFANG; XIE, CHAOFAN; FAN, HENGWEI

    2016-01-01

    The aim of the present study was to evaluate the different expression levels of thyroid hormone responsive (THRSP; Spot14)/S14 related, Mig12 (S14R) during bone marrow mesenchymal stem cell (BM-MSC) adipogenesis in adolescent idiopathic scoliosis (AIS) patients. MSCs were retrospectively isolated from AIS patients and controls, and adipogenic differentiation was induced. Total RNA was extracted for Affymetrix 3′-IVT expression profiling microarrays and compared with the results from healthy controls. The results were confirmed by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) validation and the protein expression levels of Spot14 and its paralogous gene S14R by western blotting and immunohistochemistry. A total of 300 significantly altered mRNAs were detected (111 upregulated and 189 downregulated) and confirmed by RT-qPCR. The mRNA expression levels of seven genes, including Spot14, were altered by >2-fold in AIS patients. Spot14/S14R was selected for further investigation. The results of the western blotting demonstrated that mRNA and protein expression levels of Spot14/S14R were significantly higher in AIS patients than the controls (P<0.05). Immunohistochemistry demonstrated Spot14 was expressed in 85% (17/20 cases) in adipose tissue samples from AIS patients and 23.1% (3/13 cases) of adipose tissue samples from controls. The positive ratio of Spot14 in adipose tissue samples from AIS was significantly higher than the controls (P<0.001). The results of the present study indicated that Spot14/S14R were differently expressed in MSC adipogenesis in AIS patients, and they may be important in the abnormal adipogenic differentiation in AIS. PMID:27082501

  19. The Impact of the Derotational Mobilization of Manual Therapy According to Kaltenborn-Evjenth on the Angle of Trunk Rotation in Patients with Adolescent Idiopathic Scoliosis--Pilot Study, Direct Observation.

    PubMed

    Wnuk, Bartosz; Blicharska, Irmina; Błaszczak, Edward; Durmała, Jacek

    2015-01-01

    The use of manual therapy in the treatment of scoliosis has been controversial. Scientific reports do not clearly indicate its effectiveness or harmfulness. The aim of this study was to determine the effectiveness of passive and active derotation techniques of manual therapy according to Kaltenborn-Evjent on the reduction of the angle of trunk rotation in patients with idiopathic scoliosis. The study enrolled 33 female patients from the Department of Rehabilitation who were diagnosed with adolescent idiopathic scoliosis. The patients were divided into two groups according to the curve location (SRS classification). Group A consisted of 17 women, aged 14.±2.4 years, with single-curve scoliosis in the thoracolumbar segment and group B was composed of 16 women, aged 15±2.24 years, with double-curve scoliosis in the thoracic and lumbar segments. In both groups, the angle of trunk rotation, the magnitude of thoracic kyphosis and lumbar lordosis were measured twice, before and after each session of derotation techniques. Both groups demonstrated a positive impact of active and passive derotation techniques on the angle of trunk inclination. The greatest difference was observed after a session of active derotation in the patients with lumbar scoliosis. The angle of trunk rotation decreased on average by 4.5°±1.14°. No correlations were found between the curve angle values and the degree of thoracic derotation after the application of these techniques. Derotational mobilization techniques may be a valuable complement to scoliosis treatment methods as they increase their effectiveness.

  20. Cotrel-Dubousset instrumentation in neuromuscular scoliosis.

    PubMed

    Piazzolla, Andrea; Solarino, G; De Giorgi, S; Mori, C M; Moretti, L; De Giorgi, G

    2011-05-01

    disease and spinal deformity treated between 1984 and 2008 consecutively by the senior author (G.D.G.) with Cotrel-Dubousset instrumentation and minimum 36 months follow-up were reviewed, evaluating correction of coronal deformity, sagittal balance and pelvic obliquity, and rate of complications. 24 patients (Friedreich's ataxia, 1; cerebral palsy, 14; muscular dystrophy, 2; polio, 2; syringomyelia, 3; spinal atrophy, 2) were included. According the evidence that the study period is too long (1984-2008) and that in more than 20 years many things changed in surgical strategy and techniques, all patients were divided in two groups: only hooks (8 patients) or hybrid construct (16 patients). Mean age was 18.1 years at surgery (range 11 years 7 months-max 31 years; in 17 cases the age at surgery time was between 10 and 20 years old; in 6 cases it was between 20 and 30 and only in 1 case was over 30 years old). Mean follow-up was 142 months (range 36-279). The most frequent patterns of scoliosis were thoracic (10 cases) and thoracolumbar (9 cases). In 8 cases we had hypokyphosis, in 6 normal kyphosis and in 9 hyperkyphosis. In 8 cases we had a normal lordosis, in 11 a hypolordosis and in 4 a hyperlordosis. In 1 case we had global T4-L4 kyphosis. In 8 cases there were also a thoracolumbar kyphosis (mean value 24°, min 20°-max 35°). The mean fusion area included 13 vertebrae (range 6-19); in 17 cases the upper end vertebra was over T4 and in 11 cases the lower end vertebra was over L4 or L5. In 7 cases the lower end vertebra was S1 to correct the pelvic obliquity. In 5 cases the severity of the deformity (mean Cobb's angle 84.2°) imposed a preoperative halo traction treatment. There were 5 anteroposterior and 19 posterior-only procedures. In 10 cases, with low bone quality, the arthrodesis was performed using iliac grafting technique while in the other (14 cases) using autologous bone graft obtained in situ from vertebral arches and spinous processes (in all 7 cases with

  1. SRS-22r Scores in Non-Operated Adolescent Idiopathic Scoliosis Patients with Curves Greater than Forty Degrees.

    PubMed

    Ward, W Timothy; Friel, Nicole A; Kenkre, Tanya S; Brooks, Maria M; Londino, Joanne A; Roach, James W

    2016-12-02

    Case control comparative series OBJECTIVE.: Describe surgical range adolescent idiopathic scoliosis (AIS) patients electing to forgo surgery and compare health related quality of life outcomes to a similar cohort of operated AIS patients by the same single surgeon. No data have been published either documenting SRS-22r scores of non-operated patients with curves ≥ 40° or comparing these scores to a demographically similar operated cohort. Individuals with curves ≥ 40°, age ≥ 18 years, and electing to forgo surgery were identified. All patients completed an SRS-22r questionnaire. This non-operated cohort's SRS-22r scores were compared to those of a large demographically similar cohort operated by the same surgeon. Group differences between the SRS-22r scores were evaluated by comparing these to published Minimal Clinically Important Differences (MCID) for the SRS- 22r. One hundred ninety subjects with non-operated curves were compared to 166 individuals who surgery. The non-operated cohort averaged 23.5 years of age, averaged 7.7 years since curve reached 40°, and had an average 50° Cobb angle at last follow-up. No statistical differences were found between the groups on the Pain, Function, or Mental Health domains of the SRS-22r. Statistically significant differences in favor of the operative cohort were found for Self-image, Satisfaction and Total score. The observed group differences did not meet the established thresholds for minimal clinically important differences in any of the domain scores, the average total score, or raw scores. There are no meaningful clinically significant differences in SRS-22r scores at average 8 year follow-up between AIS patients with curves ≥ 40° treated with or without surgery. These data in conjunction with an absence of long-term evidence of serious medical consequences with non-surgical management of curves ≥ 40° should encourage surgeons to reevaluate the benefits of routine surgical care. 3.

  2. Pulmonary function changes and its influencing factors after preoperative brace treatment in patients with adolescent idiopathic scoliosis

    PubMed Central

    Ran, Bo; Fan, Yuxin; Yuan, Feng; Guo, Kaijin; Zhu, Xiaodong

    2016-01-01

    Abstract Background: The aim of the study was to retrospectively investigate the changes in pulmonary function and its influencing factors in patients with adolescent idiopathic scoliosis (AIS) undergoing preoperative brace treatment or not. Methods: Total 237 AIS patients (43 boys, 194 girls) who underwent operations and had a complete record of pulmonary function tests were enrolled and were divided into preoperative brace treatment group (brace treatment group, n = 60) and without preoperative brace treatment group (control group, n = 177). The pulmonary function parameters were compared between the 2 groups. Multiple linear regression analysis was performed to explore whether the variables, including age at operation, height, coronal Cobb's angle of main curve, number of involved vertebrae, sagittal Cobb's angle of thoracic curve, brace treatment time per day and brace treatment duration, influenced pulmonary function in the brace treatment group. Results: No significant differences were observed in both predicted and actually measured value of forced vital capacity (FVC) and predicted value of forced expiratory volume in 1 s (FEV1) between 2 groups (P > 0.05), but actually measured FEV1, the percentage of actually measured and predicted value of FVC (FVC%) and FEV1 (FEV1%) were significantly lower in the brace treatment group than those in the control group (P < 0.05). Importantly, the above changes in actually measured FEV1 and FEV1% were obvious in AIS patients presented with a main thoracic curve (P < 0.05), but not in patients with a primary thoracolumbar/lumbar curve. Multiple linear regression analysis indicated that only the sagittal Cobb's angle of the thoracic curve was positively, but preoperative brace treatment duration was negatively associated with both the FVC% and FEV1% (P < 0.05). Conclusion: Preoperative brace treatment may deteriorate pulmonary function in AIS patients with thoracic curve. The small sagittal Cobb angle and

  3. [Prognostic factors of the crankshaft phenomenon in patients with scoliosis and open triradiate cartilage. Is the double approach the solution?].

    PubMed

    Pizones, J; Alvarez-González, P; Sánchez-Mariscal, F; Zúñiga, L; Izquierdo, E

    2013-01-01

    To study young patients after scoliosis surgery in order to determine risk and prevention factors for developing a crankshaft phenomenon (CP). Retrospective study of a cohort of 26 skeletally immature patients. Six were excluded due to progression of various conditions. Crankshaft was defined as an increase in the Cobb angle >10°, or an increase in the Mehta angle (DAVC) >10°, or any decrease in the apex-rib thoracic distance, or increase in the apical vertebral translation (AVT). Patients with and without CP development were compared in order to analyse preoperative, surgical and postoperative risk factors, as well as the influence of different surgical techniques. The mean follow-up was 83.9 months. Nine patients (45%) developed the crankshaft phenomenon. Only immaturity parameters were associated with development of CP. No preoperative or postoperative radiographic parameters appeared to influence its development. The amount of correction may be a protective factor (41.4 vs. 61.4%; P=.06). The double approach was able to prevent the development of CP (0%) compared with single posterior instrumentation (44%), P=.02. None of these preoperative factors seemed to predispose to CP: gender or aetiology, T5-T12 kyphosis or apical hypokyphosis, coronal Cobb, vertebral rotation, or DAVC. The residual postoperative Cobb, achieved kyphosis, or wired instrumentation versus hooks, also seemed to have no influence. In patients with open triradiate cartilage under 11 years of age, it seems advisable to correct by double approach to avoid the appearance of the crankshaft phenomenon. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  4. Raising awareness of scoliosis among children's nurses.

    PubMed

    Honeyman, Cheryl

    2014-06-01

    Scoliosis affects up to 3% of adolescents, some babies and young children, and many children with existing neuromuscular and syndromic conditions. It is the most common spinal deformity. Not all children with scoliosis require active intervention, but for more significant, progressive curves, bracing and/or surgery may be required. Bracing studies have historically been of low methodological quality, but a recent randomised controlled trial ( Weinstein et al 2013 ) has shown the efficacy of bracing in decreasing curve progression, thus reducing the necessity of surgery for some patients. Modern surgical techniques are effective in correcting scoliosis, but the surgery is major, with significant risks. Early identification of scoliosis is vital to maximise effective treatment, support the child and family, and optimise holistic health.

  5. Outpatient anterior cervical discectomy and fusion for cervical disk disease: a prospective consecutive series of 96 patients.

    PubMed

    Lied, B; Rønning, P A; Halvorsen, C M; Ekseth, K; Helseth, E

    2013-01-01

    To evaluate surgical complications and clinical outcome in a consecutive series of 96 patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical disk degeneration (CDD) in an outpatient setting. Pre-, per-, and postoperative data on patients undergoing single- or two-level outpatient ACDF at the private Oslofjord Clinic were prospectively collected. This study includes 96 consecutive patients with a mean age of 49.1 years. 36/96 had a two-level ACDF. Mean postoperative observation time before discharge was 350 min, and 95/96 were successfully discharged either to their home or to a hotel on the day of surgery. The surgical mortality was 0%, while the surgical morbidity rate was 5.2%. Two (2.1%) patients developed postoperative hematoma, 2 (2.1%) patients experienced postoperative dysphagia, and 1 (1%) experienced deterioration of neurological function. Radicular pain, neck pain, and headache decreased significantly after surgery. 91% of patients were satisfied with the surgery, according to the NASSQ. ACDF in carefully selected patients with CDD appears to be safe in the outpatient setting, provided a sufficient postoperative observation period. The clinical outcome and patient satisfaction of outpatients are comparable to that of inpatients. © 2012 John Wiley & Sons A/S.

  6. Treatment of neuromuscular scoliosis with posterior spinal fusion using the Galveston procedure: retrospective of eight years of experience with unit rod instrumentation.

    PubMed

    Gregg, Fredrick O'Neal; Zhou, Haitao; Bertrand, Styles Leslie

    2012-01-01

    Posterior spinal fusion with instrumentation to the pelvis (the Galveston Procedure) is widely accepted as an effective treatment for neuromuscular scoliosis. Unit rod instrumentation is commonly used in these cases, but it is not universally accepted as superior to separate Luque rods. This study is a retrospective review of 115 consecutive cases in which the unit rod was used. The following statistics were collected from the records of these patients: operative time, estimated blood loss, PICU stay, hospital stay, transfusion rate, complication rate, scoliosis correction, and correction of pelvic obliquity . Results at 2-year follow-up were compared to those reported in the literature and to results previously reported from the same facility in which separate Luque rods were used. The unit rod provides excellent control of pelvic obliquity and superior scoliosis correction compared with separate Luque rods. Improvements were also found in reduced operative times, lower blood loss, a lower complication rate, and shorter hospital stay.

  7. Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper

    PubMed Central

    Negrini, Stefano; Grivas, Theodoros B; Kotwicki, Tomasz; Maruyama, Toru; Rigo, Manuel; Weiss, Hans Rudolf

    2006-01-01

    Background Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments. Aim of the study To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis. Methods We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members). Results The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood. Discussion In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance. Conclusion We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation

  8. Radiation hazards in scoliosis management

    SciTech Connect

    Drummond, D.; Ranallo, F.; Lonstein, J.; Brooks, H.L.; Cameron, J.

    1983-10-01

    Safe radiography in scoliosis management is based on a sound knowledge of 1) the radiographic imaging process, 2) the degree of risk to the patient from radiation exposure, and 3) the radiographic requirements to both evaluate and follow patients with spine deformity. This paper is a current review of the subject and work done at the authors' centers. It includes recommendations for reducing the radiation risk while maintaining necessary diagnostic information.

  9. Long-term Follow-up of Pulmonary Function and Scoliosis in Patients With Duchenne's Muscular Dystrophy and Spinal Muscular Atrophy.

    PubMed

    Chua, Kenon; Tan, Chin Yik; Chen, Zhaojin; Wong, Hee Kit; Lee, Eng Hin; Tay, Stacy K H; Ong, Hian Tat; Goh, Daniel Y T; Hui, James H P

    2016-01-01

    Spine surgery for neuromuscular scoliosis in patients with Duchenne's Muscular Dystrophy (DMD) and Spinal Muscular Atrophy (SMA) remained controversial. This study aimed to review the long-term results of spine surgery and its effect on pulmonary function in these patients. A retrospective review was conducted for the above patients who had undergone surgery from 1990 to 2006 in a tertiary hospital. Their yearly lung function tests, clinical records, and x-ray films before and after surgery were reviewed. All patients had at least 2 lung function tests performed before surgery and at least 3 lung function tests performed after surgery. Records of perioperative pulmonary infections that resulted in hospital admissions were also retrieved from the hospital computer system. Forty patients were reviewed: 29 with DMD, 11 with SMA. The mean follow-up period was 11.6 years. For patients with DMD, the mean correction of Cobb's angle from surgery was 34.1 degrees. The rate of decline of the predicted forced vital capacity preoperatively was 7.80% per year, and was reduced to 4.26% per year postoperatively (P<0.001). For patients with SMA, the mean correction of Cobb's angle from surgery was 44.1 degrees. The rate of decline of the predicted forced vital capacity preoperatively was 5.31% per year, and was reduced to 1.77% per year postoperatively (P<0.001). For both DMD and SMA patients, the difference between the rate of preoperative and postoperative pulmonary infections that resulted in hospital admission were, however, not significant (P=0.433 and 0.452, respectively). Scoliosis surgery in patients with DMD and SMA results in a long-term decreased rate of decline in pulmonary function over a follow-up period of more than 10 years. The level of the apical vertebrae of the scoliosis did not demonstrate a significant trend on the pulmonary function. The frequency of chest infections did not improve by scoliosis surgery. Level III—Retrospective study.

  10. [The correlation between T1 tilt and cosmetic shoulder balance in Lenke type 2 adolescent idiopathic scoliosis patients].

    PubMed

    Qiu, Xu-sheng; Qiu, Yong; Jiang, Jun; Wang, Bin; Zhu, Ze-zhang; Qian, Bang-ping; Yu, Yang

    2013-08-01

    To study the relationship between T1 tilt and cosmetic shoulder balance in adolescent idiopathic scoliosis (AIS) patients. Seventy-one Lenke type 2 AIS patients were recruited into the present study from January 2010 to December 2011. There were 61 female and 10 male patients, the average age was (15.1 ± 2.9) years (range 10-18 years); the average Risser sign was 2.8 (range 1-5). The patients were photographed from the back in neutral standing position on level ground wearing underpants. Also, all the patients had a standing posterior-anterior radiograph in a relaxed standing position. The cosmetic shoulder height (CSH), which included cosmetic inner shoulder height (CSHi) and cosmetic outer shoulder height (CSHo), were measured in the photographs. Positive value was defined as left shoulder was higher than the right shoulder, and negative value was defined as right shoulder was higher than the left shoulder. CSH > 5 mm was defined as positive CSH, CSH < -5 mm was defined as negative CSH, -5 mm ≤ CSH ≤ 5 mm was defined as leveled CSH. T1 tilts were measured in the posterior-anterior radiographs. Positive value was defined as the left proximal vertebral body up and right lower vertebral body down, and negative value was defined as the right proximal vertebral body up and left lower vertebral body down. T1 tilt > 5° was defined as positive T1 tilt, T1 tilt < -5° was defined as negative T1 tilt, -5° ≤ T1 tilt ≤ 5° was defined as leveled T1 tilt. T1 tilt was found to be significantly correlated with CSHi and CSHo (r = 0.25 and 0.28, P < 0.05).For positive T1 tilt patients, there were 59.0% (36/61) patients with positive CSHo, 37.7% (23/61)with leveled CSHo, and 3.3% (2/61)with negative CSHo.For the patients with leveled T1 tilt, it was 3/10, 5/10 and 2/10.For positive T1 tilt patients, there were 83.6% (51/61) patients with positive CSHi, 11.5% (7/61) with leveled CSHi, and 4.9% (3/61) with negative CSHi; For the patients with leveled T1 tilt, it was 6

  11. Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response.

    PubMed

    Elliott, Robert E; Morsi, Amr; Kalhorn, Stephen P; Marcus, Joshua; Sellin, Jonathan; Kang, Matthew; Silverberg, Alyson; Rivera, Edwin; Geller, Eric; Carlson, Chad; Devinsky, Orrin; Doyle, Werner K

    2011-01-01

    The goal of this study was to assess the efficacy and safety of vagus nerve stimulation in a consecutive series of adults and children with treatment-resistant epilepsy (TRE). In this retrospective review of a prospectively created database of 436 consecutive patients who underwent vagus nerve stimulator implantation for TRE between November 1997 and April 2008, there were 220 (50.5%) females and 216 (49.5%) males ranging in age from 1 to 76 years at the time of implantation (mean: 29.0 ± 16.5). Thirty-three patients (7.6%) in the primary implantation group had inadequate follow-up (<3 months from implantation) and three patients had early device removal because of infection and were excluded from seizure control outcome analyses. Duration of vagus nerve stimulation treatment varied from 10 days to 11 years (mean: 4.94 years). Mean seizure frequency significantly improved following implantation (mean reduction: 55.8%, P<0.0001). Seizure control ≥ 90% was achieved in 90 patients (22.5%), ≥ 75% seizure control in 162 patients (40.5%), ≥ 50% improvement in 255 patients (63.75%), and <50% improvement in 145 patients (36.25%). Permanent injury to the vagus nerve occurred in 2.8% of patients. Vagus nerve stimulation is a safe and effective palliative treatment option for focal and generalized TRE in adults and children. When used in conjunction with a multidisciplinary and multimodality treatment regimen including aggressive antiepileptic drug regimens and epilepsy surgery when appropriate, more than 60% of patients with TRE experienced at least a 50% reduction in seizure burden. Good results were seen in patients with non-U.S. Food and Drug Administration-approved indications. Prospective, randomized trials are needed for patients with generalized epilepsies and for younger children to potentially expand the number of patients who may benefit from this palliative treatment. Copyright © 2010 Elsevier Inc. All rights reserved.

  12. Early detection of tumor relapse/regrowth by consecutive minimal residual disease monitoring in high-risk neuroblastoma patients

    PubMed Central

    Hirase, Satoshi; Saitoh, Atsuro; Hartomo, Tri Budi; Kozaki, Aiko; Yanai, Tomoko; Hasegawa, Daiichiro; Kawasaki, Keiichiro; Kosaka, Yoshiyuki; Matsuo, Masafumi; Yamamoto, Nobuyuki; Mori, Takeshi; Hayakawa, Akira; Iijima, Kazumoto; Nishio, Hisahide; Nishimura, Noriyuki

    2016-01-01

    Neuroblastoma is an aggressive pediatric tumor accounting for ~15% of cancer-associated mortalities in children. Despite the current intensive therapy, >50% of high-risk patients experience tumor relapse or regrowth caused by the activation of minimal residual disease (MRD). Although several MRD detection protocols using various reverse transcription-quantitative polymerase chain reaction (RT-qPCR) markers have been reported to evaluate the therapeutic response and disease status of neuroblastoma patients, their clinical significance remains elusive. The present study reports two high-risk neuroblastoma patients, whose MRD was consecutively monitored using 11 RT-qPCR markers (CHRNA3, CRMP1, DBH, DCX, DDC, GABRB3, GAP43, ISL1, KIF1A, PHOX2B and TH) during their course of treatment. The two patients initially responded to the induction therapy and reached MRD-negative status. The patients' MRD subsequently became positive with no elevation of their urinary homovanillic acid, urinary vanillylmandelic acid and serum neuron-specific enolase levels at 13 or 19 weeks prior to the clinical diagnosis of tumor relapse or regrowth. The present cases highlight the possibility of consecutive MRD monitoring using 11 markers to enable an early detection of tumor relapse or regrowth in high-risk neuroblastoma patients. PMID:27446404

  13. Abnormal osteogenic and chondrogenic differentiation of human mesenchymal stem cells from patients with adolescent idiopathic scoliosis in response to melatonin

    PubMed Central

    Chen, Chong; Xu, Caixia; Zhou, Taifeng; Gao, Bo; Zhou, Hang; Chen, Changhua; Zhang, Changli; Huang, Dongsheng; Su, Peiqiang

    2016-01-01

    Abnormalities of membranous and endochondral ossification in patients with adolescent idiopathic scoliosis (AIS) remain incompletely understood. To investigate abnormalities in the melatonin signaling pathway and cellular response to melatonin in AIS, a case-control study of osteogenic and chondrogenic differentiation was performed using human mesenchymal stem cells (hMSCs). AIS was diagnosed by physical and radiographic examination. hMSCs were isolated from the bone marrow of patients with AIS and control subjects (n=12 each), and purified by density gradient centrifugation. The expression levels of melatonin receptors (MTs) 1 and 2 were detected by western blotting. Osteogenic and chondrogenic differentiation was induced by culturing hMSCs in osteogenic and chondrogenic media containing vehicle or 50 nM melatonin. Alkaline phosphatase (ALP) activity assays, quantitative glycosaminoglycan (GAG) analysis, and reverse transcription-quantitative polymerase chain reaction analysis were performed. Compared with controls, MT2 demonstrated low expression in the AIS group. Melatonin increased ALP activity, GAG synthesis and upregulated the expression of genes involved in osteogenic and chondrogenic differentiation including, ALP, osteopontin, osteocalcin, runt-related transcription factor 2, collagen type II, collagen type X, aggrecan and sex-determining region Y-box 9 in the normal control hMSCs, but did not affect the AIS groups. Thus, AIS hMSCs exhibit abnormal cellular responses to melatonin during osteogenic and chondrogenic differentiation, which may be associated with abnormal membranous and endochondral ossification, and skeletal growth. These results indicate a potential modulating role of melatonin via the MT2 receptor on abnormal osteogenic and chondrogenic differentiaation in patients with AIS. PMID:27314307

  14. Horizontal gaze palsy and progressive scoliosis in a patient with congenital esotropia and inability to abduct. A case report.

    PubMed

    Fernández-Vega Cueto, A; Rodríguez-Ezcurra, J J; Rodríguez-Maiztegui, I

    2016-12-01

    The case is presented on a 4- year-old child with congenital esotropia, limitation of abduction, cross-fixation, and thoracolumbar scoliosis. Genetic testing of ROBO3 gene confirmed the diagnosis of horizontal gaze palsy and scoliosis (HGPSS) DISCUSSION: HGPPS is a rare congenital disorder characterised by absence of conjugate horizontal eye movements and progressive scoliosis developed in childhood and adolescence. We highlight this motility disorder as a part of the differential diagnosis of early childhood esotropia with cross- fixation and limitation of abduction. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Lateral supraorbital approach applied to sellar tumors in 23 consecutive patients: the Suzhou experience from China

    PubMed Central

    2013-01-01

    Background Pituitary adenoma, craniopharyngioma and meningioma are common sellar lesions, accounting for more than 90% of sellar tumors. The aim of this study is to assess the reliability and safety of the lateral supraorbital (LSO) approach to remove sellar tumors. Methods Between June 2011 and December 2011, 23 patients with neoplastic lesions underwent surgery by the corresponding author (ZW) via the LSO approach. The clinical presentations, neuroradiological findings, microsurgical techniques, and outcome at discharge of these patients were analyzed. In addition, the clinical series in the available literature written in English were also extensively reviewed. Eleven (48%) patients were treated for pituitary adenoma; six (26%) patients for tuberculum sellae meningioma; and six (26%) patients for craniopharyngioma. Results Seemingly complete tumor removal was achieved in 21 patients (91%); surgical mortality was one patient (4.3%). Postoperatively, no patient had developed cerebrospinal fluid leakage or new visual deficits. One (4%) patient had intracranial infection, and one (4%) had a postoperative hematoma. The median Karnofsky score at discharge was 87.4 (range, 0 to 100). The Glasgow outcome scale at discharge was 4.6 (range, 1 to 5). Of all, 21 (91.3%) patients achieved favorable outcomes. Conclusion Sellar tumors can be removed via the LSO approach with relatively low morbidity and mortality. Surgical results with this fast and simple approach are similar to those obtained with more extensive, complex, and time-consuming approaches. PMID:23432938

  16. Spinal fusion limits upper body range of motion during gait without inducing compensatory mechanisms in adolescent idiopathic scoliosis patients.

    PubMed

    Holewijn, R M; Kingma, I; de Kleuver, M; Schimmel, J J P; Keijsers, N L W

    2017-09-01

    Previous studies show a limited alteration of gait at normal walking speed after spinal fusion surgery for adolescent idiopathic scoliosis (AIS), despite the presumed essential role of spinal mobility during gait. This study analyses how spinal fusion affects gait at more challenging walking speeds. More specifically, we investigated whether thoracic-pelvic rotations are reduced to a larger extent at higher gait speeds and whether compensatory mechanisms above and below the stiffened spine are present. 18 AIS patients underwent gait analysis at increasing walking speeds (0.45 to 2.22m/s) before and after spinal fusion. The range of motion (ROM) of the upper (thorax, thoracic-pelvic and pelvis) and lower body (hip, knee and ankle) was determined in all three planes. Spatiotemporal parameters of interest were stride length and cadence. Spinal fusion diminished transverse plane thoracic-pelvic ROM and this difference was more explicit at higher walking speeds. Transversal pelvis ROM was also decreased but this effect was not affected by speed. Lower body ROM, step length and cadence remained unaffected. Despite the reduction of upper body ROM after spine surgery during high speed gait, no altered spatiotemporal parameters or increased compensatory ROM above or below the fusion (i.e. in the shoulder girdle or lower extremities) was identified. Thus, it remains unclear how patients can cope so well with such major surgery. Future studies should focus on analyzing the kinematics of individual spinal levels above and below the fusion during gait to investigate possible compensatory mechanisms within the spine. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Three-Dimensional Spinal Morphology Can Differentiate Between Progressive and Nonprogressive Patients With Adolescent Idiopathic Scoliosis at the Initial Presentation

    PubMed Central

    Nault, Marie-Lyne; Mac-Thiong, Jean-Marc; Roy-Beaudry, Marjolaine; Turgeon, Isabelle; deGuise, Jacques; Labelle, Hubert

    2014-01-01

    Study Design. This is a prospective case-control study. Objective. The objective of this study was to compare 3-dimensional (3D) morphological parameters of the spine at the first visit between a nonprogressive (NP) and a progressive (P) group of immature adolescent idiopathic scoliosis (AIS). Summary of Background Data. Prediction of curve progression remains challenging in AIS at the first visit. Prediction of progression is based on curve type, curve magnitude, and skeletal or chronological age. Methods. A prospective cohort of 133 AIS was followed from skeletal immaturity to maturity (mean, 37 mo). The first group was made up of patients with AIS with a minimum 6-degree progression of the major curve between the first and last follow-up (P) (n = 53) and the second group was composed of patients with NP who reached maturity with less than 6-degree progression (n = 81). Computerized measurements were taken on reconstructed 3-dimensional (3D) spine radiographs of the first visit. There were 6 categories of measurements: angle of plane of maximum curvature, Cobb angles (kyphosis, lordosis), 3D wedging (apical vertebra, apical disks), rotation (upper and lower junctional vertebra, apical vertebra, and thoracolumbar junction), torsion, and slenderness (height/width ratio). t tests were also conducted. Results. There was no statistical difference between the 2 groups for age and initial Cobb angle. P presented significant hypokyphosis, and parameters related to rotation presented significant statistical differences between NP and P (plane of maximal curvature, torsion, and apical axial rotation). Depth slenderness also presented statistical differences. Conclusion. This study confirms that even at the initial visit, 3D morphological differences exist between P and NP AIS. It supports the use of 3D reconstructions of the spine in the initial evaluation of AIS to help predict outcome. Level of Evidence: 3 PMID:24776699

  18. Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service.

    PubMed

    Clarke, C E; Edwards, J; Nicholl, D J; Sivaguru, A

    2010-08-01

    Guidelines recommend imaging only headache patients with sinister features in the history or on examination. We prospectively collected data on imaging newly presenting patients to a UK headache service. CT and MRI results were classified as normal or showing an insignificant or significant abnormality. Over 5 years, 3,655 new patients (69% female; mean age 42.0 years) with headache disorders were seen. Five hundred thirty (14.5%) underwent imaging with large differences in the proportion referred by each consultant. There were more insignificant abnormalities on MRI (46%) than CT (28%). There were 11 significantly abnormal results (2.1% of those imaged). Significant abnormalities were found in patients diagnosed with migraine in 1.2% and in 0.9% of those with tension-type headache. Significant abnormalities in those suspected to have an intracranial abnormality occurred in 5.5%. This supports the practice of selecting patients with suspicious findings for imaging, rather than imaging all patients.

  19. [Optimization of radiological scoliosis assessment].

    PubMed

    Enríquez, Goya; Piqueras, Joaquim; Catalá, Ana; Oliva, Glòria; Ruiz, Agustí; Ribas, Montserrat; Duran, Carmina; Rodrigo, Carlos; Rodríguez, Eugenia; Garriga, Victoria; Maristany, Teresa; García-Fontecha, César; Baños, Joan; Muchart, Jordi; Alava, Fernando

    2014-07-01

    Most scoliosis are idiopathic (80%) and occur more frequently in adolescent girls. Plain radiography is the imaging method of choice, both for the initial study and follow-up studies but has the disadvantage of using ionizing radiation. The breasts are exposed to x-ray along these repeated examinations. The authors present a range of recommendations in order to optimize radiographic exam technique for both conventional and digital x-ray settings to prevent unnecessary patients' radiation exposure and to reduce the risk of breast cancer in patients with scoliosis. With analogue systems, leaded breast protectors should always be used, and with any radiographic equipment, analog or digital radiography, the examination should be performed in postero-anterior projection and optimized low-dose techniques. The ALARA (as low as reasonable achievable) rule should always be followed to achieve diagnostic quality images with the lowest feasible dose. Copyright © 2014. Published by Elsevier Espana.

  20. Clinical Outcomes of Heart-Lung Transplantation: Review of 10 Single-Center Consecutive Patients

    PubMed Central

    Yun, Jae Kwang; Choi, Se Hoon; Park, Seung-Il

    2016-01-01

    Background Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. Methods Between July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients’ baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of 26.1±16.7 months. Results Early death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively. Conclusion HLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care. PMID:27298792

  1. Analysis for speech and esthetics in sixty consecutive patients with cleft lip and palate

    PubMed Central

    Shiraganvi, Mahantesh S; Kumar, N; Desai, A; Kiran, TUR; Gopalkrishnan, K

    2012-01-01

    Background A double-blind retrospective study was carried out at our oral and maxillofacial surgery department to assess speech and esthetics of primary cheiloplasty in patients operated for unilateral complete cleft lip, alveolus and palate. Materials and Methods Total sample size was 60. All were operated for unilateral complete cleft lip, alveolus and palate. Age range was between 1 and 21 years. Results of surgeries performed by two surgeons were assessed. The speech of all these patients was judged by a single speech therapist who was unaware of the operating surgeon. All patients were assessed for articulatory errors, namely, omission, distortion, substitution, addition and intelligibility. Sixty-eight words in local language (Kannada) were selected by the speech pathologist. All patients were subdivided into three age groups: ≤5 years, 6-10 years and ≥11 years. The cheiloplasty was assessed using VLS (V: vermilion, L: lip, S: scar) scale for vermilion, lip and scar patterns. Results and Conclusion Patients undergoing palatoplasty in ≤1 year showed good articulation between the age of 5 and 10 years. Articulation and intelligibility was maximum in patients ≥11 years. Patients at this age try various compensatory mechanisms to overcome communication disabilities. Based on the VLS scale, scarring was the least in all patients. Vermilion and lip patterns showed satisfactory results in most of the patients. PMID:25756010

  2. Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats.

    PubMed

    Wegner, Felix K; Silvano, Maria; Bögeholz, Nils; Leitz, Patrick R; Frommeyer, Gerrit; Dechering, Dirk G; Zellerhoff, Stephan; Kochhäuser, Simon; Lange, Philipp S; Köbe, Julia; Wasmer, Kristina; Mönnig, Gerold; Eckardt, Lars; Pott, Christian

    2017-02-01

    Slow pathway modification (SPM) is the therapy of choice for AV-nodal reentry tachycardia (AVNRT). When AVNRT is not inducible, empirical ablation can be considered, however, the outcome in patients with two AV nodal echo beats (AVNEBs) is unknown. Out of a population of 3003 patients who underwent slow pathway modification at our institution between 1993 and 2013, we retrospectively included 32 patients with a history of symptomatic tachycardia, lack of paroxysmal supraventricular tachycardia (pSVT) inducibility but occurrence of two AVNEBs. pSVT documentation by electrocardiography (ECG) was present in 20 patients. The procedural endpoint was inducibility of less than two AVNEBs. This was reached in 31 (97%) patients. Long-term success was assessed by a telephone questionnaire (follow-up time 63±9 months). A total 94% of the patients benefited from the procedure (59% freedom from symptoms; 34% improvement in symptoms). Among those patients in whom ECG documentation was not present, 100% benefited (58% freedom from symptoms, 42% improvement). This is the first collective analysis of a group of patients presenting with symptoms of pSVT and inducibility of only two AVNEBs. Procedural success and clinical long-term follow-up were in the range of the reported success rates of slow pathway modification of inducible AVNRT, independent of whether ECG documentation was present. Thus, SPM is a safe and effective therapy in patients with two AVNEBs. Copyright © 2016. Published by Elsevier Ltd.

  3. Technical aspects and outcome after prophylactic mastectomy and immediate breast reconstruction in 30 consecutive high-risk patients.

    PubMed

    Wickman, Marie; Sandelin, Kerstin; Arver, Brita

    2003-03-01

    The purpose of this study was to evaluate a consecutive series of patients operated on with prophylactic mastectomy and immediate breast reconstruction with implants, focusing on preoperative assessment, technical aspects of surgical outcome, and number of postoperative complications on a short-term basis. Thirty consecutive healthy women with an increased risk of breast cancer who were therefore operated on with bilateral prophylactic mastectomy and immediate breast reconstruction are reported. A multidisciplinary approach with a geneticist, general surgeon, plastic surgeon, specially trained nurse, psychologist, gynecologist, and oncologist was used preoperatively, with thorough information provided to the patient about the surgery. Eleven patients had gene mutations, and in all patients, the geneticist had performed a risk assessment. The mean age of the patients was 41 years. The technique was modified over time with smaller or special incisions and tailor-made adjustments for each patient. Great care was taken to remove all breast tissue. The tops of the breast nipples were regrafted for cosmetic purposes, and the base was sent for histopathologic examination. In most cases, permanent expander prostheses with detachable valves were used. The areolas were tattooed, if they were not left in place. No patient had occult cancer or carcinoma in situ. Four postoperative complications occurred, including two hematomas, one infection (treated with antibiotics), and one pneumothorax in a patient with severe asthma. All reconstructions were fulfilled. The mean hospital stay was 5.7 days. The time from mastectomy to the final tattooing of the areolas was 260 days. All patients returned to normal daily activities after fulfilled reconstruction.

  4. Preperitoneal catheter analgesia is an effective method for pain management after colorectal surgery: the results of 100 consecutive patients

    PubMed Central

    Ozer, Ali; Yılmazlar, Aysun; Oztürk, Ersin; Yılmazlar, Tuncay

    2014-01-01

    Background In a previous prospective randomized trial, we showed that local anesthetic infusion using a preperitoneal catheter is an effective postoperative analgesic method following colorectal resections. Over time, we have improved the technique of preperitoneal catheter analgesia. In this prospective cohort study, we report the results of 100 consecutive patients who underwent colorectal resections. Materials and methods Preperitoneal catheter analgesia was performed via a multihole catheter placed in the preperitoneal space using 10 mL 0.5% levobupivacaine every 4 hours following the operation for the first 3 days. Additional analgesics were used whenever necessary. Postoperative pain was assessed with the visual analog scale score. Short-term clinical outcomes, such as need for systemic analgesics, time to first gas and stool discharge, length of hospital stay, and morbidity, particularly surgical site infections, were reported. Results From May 2009 to May 2010, 100 consecutive patients were recruited in the study. A total of 83 patients were operated on for malignancy, and the tumor was located in the rectum in 52 patients and in the colon in 31 patients. The median pain score was 4 (0–6), 3 (0–9), 2 (0–8), 1 (0–8), 1 (0–6), 0 (0–6), and 0 (0–3) at postoperative hours 0, 1, 4, 12, 24, 48, and 72, respectively. Additional analgesics were required in 34 patients: 21 of them required only nonsteroidal anti-inflammatory drugs, and 13 patients needed opioids additionally. The median amounts of opioid analgesics and nonsteroidal anti-inflammatory drugs were 1.76±0.78 mg and 6.70±1.18 mg, respectively. However, almost all of the additional analgesics were given in the first 24 hours. Surgical site infections were detected in eight patients. Conclusion Preperitoneal catheter analgesia is an effective analgesic method. When applied and used properly, it may even be used as the sole analgesic method in some patients. PMID:25336988

  5. "Paraduodenal" pancreatitis: results of surgery on 58 consecutives patients from a single institution.

    PubMed

    Casetti, L; Bassi, C; Salvia, R; Butturini, G; Graziani, R; Falconi, M; Frulloni, L; Crippa, S; Zamboni, G; Pederzoli, P

    2009-12-01

    Cystic dystrophy of heterotopic pancreas, groove pancreatitis, pancreatic hamartoma of the duodenum, paraduodenal wall cyst, and myoadenomatosis are all terms grouped together, from a pathological viewpoint, as definitions of paraduodenal pancreatitis (PP). The objective of the present study was to investigate the clinical characteristics, therapeutic strategies, and results in 58 patients undergoing pancreatic resection for PP. From January 1990 to December 2006 data were prospectively collected on 58 patients who were diagnosed with PP who then underwent pancreaticoduodenectomy. In this patient cohort the median age was 44.7 years; only 4 patients were women, and only 3 had non-drinker and/or non smoker habits. The overall morbidity was 18.9%, and the median hospitalization was 11 days. There were no postoperative deaths. In a median follow-up of 96.3 months, all patients noted a decrease in the pain associated with PP; 35 patients (76%) had complete disappearance of pain, whereas occasional relapsing pain occurred in the remaining 11 (24%). Patients with PP have clinical characteristics similar to those of chronic pancreatitis. The diagnostic imaging modalities of choice are ultrasonographic endoscopy and magnetic resonance cholangiopancreaticography. Based on our surgical experience, pancreaticoduodenectomy seems to be a reasonable choice of treatment in patients with PP.

  6. Traumatic brain injury due to gunshot wounds: a single institution's experience with 442 consecutive patients.

    PubMed

    Solmaz, Ilker; Kural, Cahit; Temiz, Cağlar; Seçer, Halil Ibrahim; Düz, Bülent; Gönül, Engin; Izci, Yusuf

    2009-07-01

    Traumatic brain injury (TBI) caused by a gunshot wound is a complex injury with a broad spectrum of symptoms and high rates of mortality and morbidity. This study presents an evaluation of TBI caused by gunshot wounds presenting at a single institution and discusses possible predictive factors for the outcome of surgical intervention. The study sample consisted of 442 patients who underwent surgery for TBI over a 16-year period. All injuries were caused by gunshot wounds, such as bullets and shrapnel. All patients underwent surgical intervention. Almost all patients (99.3%) were male, and the mean patient age was 22.3 years. Wounds were caused by shrapnel in 68 percent of patients. The Glasgow Coma Scale (GCS) score at admission was below 8 in 116 patients (26.2%) and above 8 in 326 patients (73.8%). In total, 47 patients (10.6%) died despite surgical management, with diffuse brain injury the most common cause of death. Low GCS scores, ventricular injuries and bihemispheric injuries are correlated with poor prognosis. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates.

  7. Clinical experience with the Fraxel SR laser: 202 treatments in 59 consecutive patients.

    PubMed

    Cohen, Steven R; Henssler, Cory; Horton, Kelly; Broder, Kevin W; Moise-Broder, Pamela A

    2008-05-01

    The authors investigated postprocedure patient satisfaction after fractional photothermolysis with the Fraxel SR laser. All patients were surveyed with respect to their satisfaction with the results using a Likert scale ranging from 1 to 5, with 5 = extremely satisfied and 1 = extremely dissatisfied. Fraxel SR laser treatment was performed for categories of skin abnormalities that included dyschromia, scarring, and texture abnormalities. Most patients had more than one concern. Univariate and multivariate analyses were performed. Logistic regression was used to explore predictors of a satisfaction score of 4 or 5. Fifty-nine patients (median age, 52 years; range, 30 to 71 years) underwent Fraxel SR laser resurfacing and completed the survey. A total of 202 treatments (median, four; range, one to six) were performed. Seventy-five percent of all patients were very satisfied (4 or 5 rating) with treatment. Seventy-five percent with dyschromia, 74 percent with texture abnormalities, and 100 percent with scarring had a satisfaction score of 4 or 5. Multivariate analysis found scarring, four or more treatments, and age older than 56 years to be associated with a score of 4 or 5. The odds of giving a satisfaction score of 4 or 5 increased approximately two-fold for each additional treatment a patient received. This study reports the largest experience to date with the clinical use of the Fraxel SR laser and is the first report of patient satisfaction after fractional photothermolysis. Patients reported high satisfaction rates for improvements in texture, dyschromia, and scarring.

  8. The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery.

    PubMed

    Boissière, Louis; Bourghli, Anouar; Vital, Jean-Marc; Gille, Olivier; Obeid, Ibrahim

    2013-06-01

    Sagittal malalignment is frequently observed in adult scoliosis. C7 plumb line, lumbar lordosis and pelvic tilt are the main factors to evaluate sagittal balance and the need of a vertebral osteotomy to correct it. We described a ratio: the lumbar lordosis index (ratio lumbar lordosis/pelvic incidence) (LLI) and analyzed its relationships with spinal malalignment and vertebral osteotomies. 53 consecutive patients with a surgical adult scoliosis had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters and LLI. The lack of lordosis was calculated after prediction of theoretical lumbar lordosis. Correlation analysis between the different parameters was performed. All parameters were correlated with spinal malalignment but LLI is the most correlated parameter (r = -0.978). It is also the best parameter in this study to predict the need of a spinal osteotomy (r = 1 if LLI <0.5). LLI is a statistically validated parameter for sagittal malalignment analysis. It can be used as a mathematical tool to detect spinal malalignment in adult scoliosis and guides the surgeon decision of realizing a vertebral osteotomy for adult scoliosis sagittal correction. It can be used as well for the interpretation of clinical series in adult scoliosis.

  9. Discrepancy between radiographic shoulder balance and cosmetic shoulder balance in adolescent idiopathic scoliosis patients with double thoracic curve.

    PubMed

    Qiu, Xu-sheng; Ma, Wei-wei; Li, Wei-guo; Wang, Bin; Yu, Yang; Zhu, Ze-zhang; Qian, Bang-ping; Zhu, Feng; Sun, Xu; Ng, Bobby K W; Cheng, Jack C Y; Qiu, Yong

    2009-01-01

    Shoulder balance is one of the key components to the body deformity in adolescent idiopathic scoliosis (AIS) patients with double thoracic curve and shoulder cosmesis plays an important role in patients' satisfaction of surgical outcomes. Up to now, only radiographic parameters were used to evaluate the shoulder balance in literatures; no corresponding cosmetic parameters have been developed to evaluate the cosmetic shoulder balance. Meanwhile, we often confronted that perfect radiographic shoulder balance was achieved, but the patients complained about the residual cosmetic deformity. This phenomenon implied that discrepancy may exist between radiographic shoulder balance and cosmetic shoulder balance. The present study was carried out to investigate the correlation between radiographic and clinical cosmetic shoulder balance in AIS patients with double thoracic curve. Thirty-four AIS patients were recruited for this study. All the patients had a double thoracic curve. Six cosmetic parameters--inner shoulder height (SHi), outer shoulder height (SHo), shoulder area index 1 (SAI1), shoulder area index 2 (SAI2), shoulder angle (alpha1) and axilla angle (alpha2) were developed and measured on the standing photographs. Also, seven radiographic parameters--T1 tilting (T1), first rib angle (FRA), clavicle angle (CA), coracoid process height (CPH), clavicle-rib cage intersection (CRCI), first rib-clavicle height (FRCH), trapezius length (TL) were measured on the standing posterior-anterior radiographs. Correlation analysis was made between cosmetic parameters and radiographic parameters. SHi was found to be significantly correlated with T1, FRA, CA, CPH, CRCI (P < 0.05), among which FRA had the highest correlation coefficient. SHo was found to be significantly correlated with T1, FRA, CA, CPH, CRCI, FRCH (P < 0.05), among which CRCI had the highest correlation coefficient. However, none of the correlation coefficient was greater than 0.8. The correlation coefficients

  10. Thoracic outlet syndrome: Fact or fancy? A review of 409 consecutive patients who underwent operation

    PubMed Central

    Jamieson, William G.; Chinnick, Barbara

    1996-01-01

    Objectives From an analysis of patients operated on by a single surgeon between 1973 and 1994 for thoracic outlet syndrome (TOS), to determine what findings are helpful in substantiating this diagnosis and what are the results of decompressive thoracic outlet surgery in the management of TOS. Design A chart review with emphasis on signs, symptoms and results. A preoperative questionnaire was presented to all patients operated on since 1989. Postoperative follow-up was by interview or telephone. Setting A 560-bed university-affiliated tertiary-care teaching hospital. Patients There were 409 adults; 83% were women and the average age was 36 years. In 95% of patients physiotherapy had been unsuccessful. Patients presented with neurologic type (368 [(90%]), arterial impingement (29 [7%]) and venous obstructive symptoms (12 [3%]). The series included 44 patients with bilateral symptoms and 26 patients with cervical ribs. Some form of litigation or compensation was associated with 177 patients. Interventions Transaxillary first rib resection in 380 (93%) patients and supraclavicular thoracic outlet decompression in 29 (7%). In 244 patients there was a follow-up of at least 2 years. These patients constituted the follow-up group. Results Preoperatively, in the 368 patients who had neurologic TOS, 99% displayed supraclavicular brachial plexus tenderness and 98% exacerbation of symptoms with arms in the abduction external rotated position. There were eight complications of surgical intervention (1.9%). In the follow-up group, there were no deaths, no subclavian/axillary artery or vein damage and no brachial plexus injury. Seventy-eight percent of the patients with neurologic TOS in this group improved postoperatively; 21% had complete relief, 32% had good relief and 25% had fair relief. Twenty-two percent showed no improvement. Conclusions Signs and symptoms helpful in making the diagnosis of neurologic TOS are supraclavicular tenderness on palpation and exacerbation of

  11. Rorschach inkblot method data at baseline and after 2 years treatment of consecutively admitted patients with first-episode schizophrenia.

    PubMed

    Rosenbaum, Bent; Andersen, Palle Bent; Knudsen, Per Bjerregaard; Lorentzen, Pia

    2012-04-01

    The Rorschach Inkblot Method is regarded as an important clinical instrument for detailed diagnostic description of the integrative capacities of individuals in psychotic states and as an instrument for measuring progression in the course of treatment. To describe relevant Rorschach variables at baseline in a group of consecutively admitted patients with first-episode schizophrenia. Furthermore, to describe the changes in these variables from baseline to year 2 for the group of patients given psychiatric standard treatment, and to compare these changes with changes in other outcome measures [Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Strauss-Carpenter and socio-demographic variables]. In a prospective study, 34 patients consecutively admitted to treatment for a first episode of schizophrenia were tested using Exner's Rorschach Comprehensive System at inclusion and after 2 years. Core variables of the Rorschach, assumed to show changes (e.g. reality testing, perceptual and thought disorders) in patients with a first episode of schizophrenia, all improved but revealed no significant changes after 2 years of treatment, while other measurements (PANSS, GAF) did. Furthermore, discrepancies were found between the Perceptual-Thinking Index (PTI) and PANSS(positive) symptoms of delusions and hallucinations. The small sample limits the conclusions, but the Rorschach variables may have problems reflecting major changes in psychotic symptoms and social functioning. With short protocols, PTI seems at risk of being unnecessarily insensitive and PTI may benefit from changes in the scoring procedures.

  12. Radiation enteritis and radiation scoliosis

    SciTech Connect

    Shah, M.; Eng, K.; Engler, G.L.

    1980-09-01

    Any patient with radiation scoliosis should be suspected of having a visceral lesion as well. Chronic radiation enteritis may be manifested by intestinal obstruction, fistulas, perforation, and hemorrhage. Intestinal obstruction is the most common complication, and must be differentiated from postoperative cast or from spinal-traction syndrome. Obstruction that does not respond promptly to conservative measures must be treated surgically. Irradiated bowel is ischemic, and necrosis with spontaneous perforation can only be avoided with early diagnosis and surgical intervention.

  13. Medication-Overuse Headache: Protocols and Outcomes in 149 Consecutive Patients in a Tertiary Brazilian Headache Center.

    PubMed

    Krymchantowski, Abouch V; Tepper, Stewart J; Jevoux, Carla; Valença, Marcelo

    2017-01-01

    Medication-overuse headache (MOH) is a challenging clinical disorder often resulting in frustration for patients and physicians. Adherence issues are common and limited treatment evidence is an obstacle to effective care. Individual bias usually directs the treatment. The aim of this study was to evaluate outcome and treatment strategies in consecutive MOH patients from a tertiary center. Every consecutive patient seen between January and December 2014 with the diagnosis of MOH was included. Psychiatric comorbidities, inability to report baseline headache frequency, current or previous 2-month use of preventive medications, and refusal to sign informed consent were exclusion criteria. The patients were evaluated by the same specialist (AVK) in thorough initial consultations. The diagnosis and treatment strategies were clearly explained, and a detailed headache diary was given to all patients. Endpoints were headache frequency and adherence after 2, 4, and 8 months. One hundred sixty-eight patients (31 M, 137 F) met the inclusion criteria. Nineteen patients (11.3%) were excluded. All patients had migraine or chronic migraine as primary headache. Mean baseline frequency was 24.8 headache days/month, average headache history was 20.6 years (1-37), and mean time with > 15 headache days/month was 4.8 years (.5-32). All patients were overusing acute symptomatic medications (SM), and 59 (39.5%) were using more than one pharmacological class. Outpatient withdrawal from overused medications was carried out with all patients, who received different preventive treatment choices and triptan plus NSAID for the acute attacks (maximum of 2 days/week). One hundred and one patients (67.8%) received prednisone during the first 5-7 days. After 2 months, 30 (20.1%) were lost to follow-up, and in those who followed up, the mean headache frequency decreased to 10.7 headache days/month (ITT 13.1). After 4 and 8 months, 109 and 105 patients, respectively, were under treatment, with a

  14. Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year Experience

    PubMed Central

    2012-01-01

    Background Refusal of heterogenic blood products can be for religious reasons as in Jehovah's Witnesses or otherwise or as requested by an increasing number of patients. Furthermore blood reserves are under continuous demand with increasing costs. Therefore, transfusion avoidance strategies are desirable. We describe a historic comparison and current results of blood saving protocols in Jehovah's Witnesses patients. Methods Data on 250 Jehovah's Witness patients operated upon between 1991 and 2003 (group A) were reviewed and compared with a second population of 250 patients treated from 2003 to 2012 (group B). Results In group A, mean age was 51 years of age compared to 68 years in group B. An iterative procedure was performed in 13% of patients in group B. Thirty days mortality was 3% in group A and 1% in group B despite greater operative risk factors, with more redo, and lower ejection fraction in group B. Several factors contributed to the low morbidity-mortality in group B, namely: preoperative erythropoietin to attain a minimal hemoglobin value of 14 g/dl, warm blood cardioplegia, the implementation of the Cornell University protocol and fast track extubation. Conclusions Cardiac surgery without transfusion in high-risk patients such as Jehovah Witnesses can be carried out with results equivalent to those of low risk patients. Recent advances in surgical techniques and blood conservation protocols are main contributing factors. PMID:23013647

  15. Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year experience.

    PubMed

    Vaislic, Claude D; Dalibon, Nicolas; Ponzio, Oliver; Ba, Maguette; Jugan, Eric; Lagneau, Franck; Abbas, Philippe; Olliver, Yves; Gaillard, Didier; Baget, Francois; Sportiche, Michel; Chedid, Antoine; Chaoul, Georges; Maribas, Philippe; Dupuy, Christiane; Robine, Bruno; Kasanin, Nicolas; Michon, Herve; Ruat, Jean-Michel; Habis, Michel; Bouharaoua, Touhami

    2012-09-27

    Refusal of heterogenic blood products can be for religious reasons as in Jehovah's Witnesses or otherwise or as requested by an increasing number of patients. Furthermore blood reserves are under continuous demand with increasing costs. Therefore, transfusion avoidance strategies are desirable. We describe a historic comparison and current results of blood saving protocols in Jehovah's Witnesses patients. Data on 250 Jehovah's Witness patients operated upon between 1991 and 2003 (group A) were reviewed and compared with a second population of 250 patients treated from 2003 to 2012 (group B). In group A, mean age was 51 years of age compared to 68 years in group B. An iterative procedure was performed in 13% of patients in group B. Thirty days mortality was 3% in group A and 1% in group B despite greater operative risk factors, with more redo, and lower ejection fraction in group B. Several factors contributed to the low morbidity-mortality in group B, namely: preoperative erythropoietin to attain a minimal hemoglobin value of 14 g/dl, warm blood cardioplegia, the implementation of the Cornell University protocol and fast track extubation. Cardiac surgery without transfusion in high-risk patients such as Jehovah Witnesses can be carried out with results equivalent to those of low risk patients. Recent advances in surgical techniques and blood conservation protocols are main contributing factors.

  16. [Adolescent idiopathic scoliosis].

    PubMed

    2016-12-01

    Adolescent idiopathic scoliosis is a 3D spinal deformity in frontal, sagittal and axial planes, with high relevance in the pediatric population especially in adolescents and females between 10 years of age and the end of growth spurt and skeletal maturity. The radiographic manifestation is a curve greater than 10° measured by Cobb method associated with vertebral rotation. "Idiopathic" diagnosis has to be done after neuroanatomical anomalies of the posterior cerebral fosa and spinal canal have been ruled out. The physical finding of a thoracic or lumbar hump is the clinical manifestation of vertebral rotation seen in a forward bending test (Adam's Test). It is recommended that all curves with a magnitude greater than 20° have to be controlled and treated by a spinal surgeon being observation, bracing and surgery the different treatment options based on the extent, progression of deformity and basically the clinical condition of the patient.

  17. Scoliosis associated with neurofibromatosis.

    PubMed

    Crawford, Alvin H; Herrera-Soto, Jose

    2007-10-01

    Neurofibromatosis type 1 (NF-1) is a multisystemic disease. It may manifest as abnormalities of the nervous tissue, bones, soft tissue, and skin. The manifestations of NF-1 vary from person to person and range from subclinical to severe. Individuals who carry the gene eventually exhibit some clinical feature of the disease. The penetrance for NF-1 nears 100% during adulthood. Skeletal abnormalities are common in NF-1, with most patients presenting with some type of bony dysplasia. The orthopedic complications usually appear early. They include spinal deformities, such as scoliosis or kyphosis, congenital tibial dysplasia with bowing and pseudarthrosis of the tibia, forearm, other bones, as well as overgrowth phenomenon of an extremity, and soft tissue tumors.

  18. Lumbar plexus block surface landmarks as assessed by computed axial tomography in adult patients with scoliosis: a case series.

    PubMed

    Robards, Christopher B; Riutort, Kevin; Thomas, Colleen S; Porter, Steven B; Wang, R Doris; Clendenen, Steven R; Runyan, Brandon R; Greengrass, Roy A

    2015-04-01

    Lumbar plexus (LP) block is a common and useful regional anesthesia technique. Surface landmarks used to identify the LP in patients with healthy spines have been previously described, with the distance from the spinous process (SP) to the skin overlying the LP being approximately two-thirds the distance from the SP to the posterior superior iliac spine (PSIS) (SP-LP:SP-PSIS ratio). In scoliotic patients, rotation of the central neuraxis may make these surface landmarks unreliable, possibly leading to an increased block failure rate and an increased incidence of complications. The objective of the present study was to describe these surface landmarks of the LP in patients with scoliosis. We selected 47 patients with known thoracolumbar scoliotic disease from our institution's radiology archives. We measured bony landmark geometry, Cobb angle, and the LP location and depth. Additionally, we calculated the SP-LP:SP-PSIS ratio for both the concave and convex sides. In scoliotic patients (31 females and 16 males), the median (range) Cobb angle was 23 (8-54) degrees. The LP depth was 7.5 (5.7-10.7) cm on the concave side of the scoliotic spine and 7.6 (5.4-10.8) cm on the convex side, while the distance from the SP-LP was 3.4 (1.9-4.7) cm on the concave side and 3.7 (2.4-5.1) cm on the convex side. The SP-LP:SP-PSIS ratio was 0.61 (0.20-0.97) and 0.65 (0.45-0.98) on the concave and convex sides, respectively. None of these distances were significantly different between sides. In patients with scoliotic disease of the spine, there is wide variability in the bony surface landmarks. The location of the LP is generally more medial than expected when compared with both modified and traditional landmarks. A review of the imaging studies and the pre-procedural ultrasound assessment of the anatomy should be considered prior to needle puncture.

  19. Mucosal proctectomy and ileoanal pull-through technique and functional results in 23 consecutive patients.

    PubMed

    Bodzin, J H; Kestenberg, W; Kaufmann, R; Dean, K

    1987-07-01

    Mucosal proctectomy with ileoanal pull-through in the treatment of ulcerative colitis and familial polyposis provides a technique for the preservation of the anal sphincters and relatively normal mechanisms of continence. Five patients had straight ileoanal anastomosis while 18 had the construction of a J-pouch. A two-team approach was used for simultaneous abdominal and perineal procedures to facilitate a shortened operating time. A loop ileostomy was routinely used in the postoperative period and was closed an average of 4.5 months (range: 2-16 months) later without complication. Prolonged preoperative hospitalization was rarely necessary and outpatient steroid enema preparation was routinely used. There were no deaths. Nineteen patients with functioning pull-through procedures have been followed an average of 23 months (range: 3-42 months). Two other patients have not had ileostomy closure because of complications. The two remaining patients had intractable diarrhea and have since undergone conversion to a permanent ileostomy. The 19 patients are continent, having three to nine bowel movements each day. Nearly all wear a perineal sanitary pad because of rare, unpredictable leakage of small amounts of fluid, especially at night. Complications were significant in this group of patients. Intestinal obstruction was a frequent problem, occurring in 52 per cent of the entire series and necessitating reoperation in 22 per cent. Anal stricture was a problem in another five patients. A variety of other minor problems occurred and most were treated nonoperatively. In spite of moderate diarrhea and occasional leakage of stool, all patients with functioning pull-through procedures prefer their current status to life with an ileostomy.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome.

    PubMed

    Bonfils, S; Landor, J H; Mignon, M; Hervoir, P

    1981-12-01

    Hospital records and follow-up information on 92 patients with surgically proven Zollinger-Ellison syndrome have been reviewed, and data relating to symptomatology, age and sex incidence, pathologic findings, and early and late results of surgical procedures have been summarized. The postoperative mortality rate was 15%, and was adversely affected by previous peptic ulcer surgery, by the necessity of urgent operation for complications of peptic ulcer, and by employment of a procedure that failed to control acid secretion. Thirteen patients were found to have primary gastrinomas of the duodenum and an additional 13 patients had islet cell hyperplasia without evidence of frank neoplasm; prognosis in these two groups appears to be particularly favorable. Despite the current availability of effective nonoperative measures for control of gastric hypersecretion, surgical exploration is warranted in all patients to determine location and extent of tumor and to attempt to control the ulcer diathesis by resection of tumor. Long-term therapy with H2 receptor antagonists is advised for patients whose hypersecretory state has not been alleviated by tumor resection or whose gastrinoma cannot be removed. Total gastrectomy is still indicated in patients whose tumors are not amenable to resection and who are resistant to, or cannot follow, a rigid medical regimen.

  1. Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome.

    PubMed Central

    Bonfils, S; Landor, J H; Mignon, M; Hervoir, P

    1981-01-01

    Hospital records and follow-up information on 92 patients with surgically proven Zollinger-Ellison syndrome have been reviewed, and data relating to symptomatology, age and sex incidence, pathologic findings, and early and late results of surgical procedures have been summarized. The postoperative mortality rate was 15%, and was adversely affected by previous peptic ulcer surgery, by the necessity of urgent operation for complications of peptic ulcer, and by employment of a procedure that failed to control acid secretion. Thirteen patients were found to have primary gastrinomas of the duodenum and an additional 13 patients had islet cell hyperplasia without evidence of frank neoplasm; prognosis in these two groups appears to be particularly favorable. Despite the current availability of effective nonoperative measures for control of gastric hypersecretion, surgical exploration is warranted in all patients to determine location and extent of tumor and to attempt to control the ulcer diathesis by resection of tumor. Long-term therapy with H2 receptor antagonists is advised for patients whose hypersecretory state has not been alleviated by tumor resection or whose gastrinoma cannot be removed. Total gastrectomy is still indicated in patients whose tumors are not amenable to resection and who are resistant to, or cannot follow, a rigid medical regimen. PMID:7030236

  2. Clinical course and management of a consecutive series of patients with "healed temporal arteritis".

    PubMed

    Lee, Yvonne C; Padera, Robert F; Noss, Erika H; Fossel, Anne H; Bienfang, Don; Liang, Matthew H; Docken, William P

    2012-02-01

    To describe the clinical course and management of patients with a pathologic diagnosis of "healed" giant cell arteritis (GCA), and to determine whether previously published histological descriptions of healed arteritis can identify patients with a greater likelihood of clinically significant arteritis. All temporal artery biopsy reports between 1994 and 2003 were examined for a diagnosis of "healed arteritis." Two rheumatologists abstracted the medical record for presenting features, physical findings, comorbid conditions, and data on treatment and outcomes. One pathologist, blinded to the clinical data, reviewed all specimens and reinterpreted the biopsies according to published histological descriptions of healed arteritis. Forty-seven patients with an initial pathologic diagnosis of healed arteritis were identified. In 54% of these patients, corticosteroid therapy did not change after the diagnosis of healed arteritis was documented in the pathology report. Seventy percent were ultimately treated with no corticosteroids or low-moderate corticosteroid regimens. Only 32% of the initial cases were confirmed upon review of the biopsies using standardized histological criteria. Patients with confirmed healed arteritis were more likely to have a documented history of polymyalgia rheumatica/GCA and a longer duration of corticosteroid treatment before biopsy. These patients were not more likely to have adverse outcomes. In this case series, the diagnosis of healed arteritis had little effect on treatment decisions. In most cases, the initial pathologic diagnosis of healed arteritis was not confirmed when biopsies were reviewed by a single pathologist using uniform histological criteria.

  3. Cognitive and adaptive evaluation of 21 consecutive patients with Dravet syndrome.

    PubMed

    Villeneuve, Nathalie; Laguitton, Virginie; Viellard, Marine; Lépine, Anne; Chabrol, Brigitte; Dravet, Charlotte; Milh, Mathieu

    2014-02-01

    In order to assess the cognitive and adaptive profiles of school-aged patients with Dravet syndrome (DS), we proposed to evaluate the intelligence and adaptive scores in twenty-one 6- to 10-year-old patients with DS followed in our institution between 1997 and 2013. Fourteen patients were tested using the Wechsler Intelligence Scale for Children (WISC) and the Vineland Adaptive Behavioral Scales (VABS); 6 patients could not be tested with the WISC and were tested with the VABS only, and one was tested with the WISC only. Data regarding the epilepsy were retrospectively collected. Statistical analysis (Spearman rank order and Pearson correlation coefficient) was used to correlate early epilepsy characteristics with the cognitive and adaptive scores. Sodium channel, neuronal alpha-subunit type 1 (SCN1A) was mutated in 19 out of 21 patients. After the age of 6years, none of the DS patients had a normal intelligence quotient (IQ) using WISC (age at the testing period: mean=100±5; median=105months; mean total IQ=47±3; n=15). Only five patients had a verbal and/or a non verbal IQ of more than 60 (points). Their cognitive profile was characterized by an attention deficit, an inability to inhibit impulsive responses, perseverative responses and deficit in planning function. Administering the Vineland Adaptive Behavioral Scales in the same period, we showed that socialization skills were significantly higher than communication and autonomy skills (age at the testing period: mean=100±4; median=100months; n=20). We did not find any significant correlation between the IQ or developmental quotient assessed between 6 and 10years of age and the quantitative and qualitative parameters of epilepsy during the first two years of life in this small group of patients. Despite an overall moderate cognitive deficit in this group of patients, the Vineland Adaptive Behavioral Scales described an adaptive/behavioral profile with low communication and autonomy capacities, whereas the

  4. Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation

    PubMed Central

    Ates, Bülent; Akalin, Serdar; Citak, Mehmet; Kaya, Alper; Alanay, Ahmet

    2006-01-01

    Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4±1.9 and mean follow-up period was 136.9±12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8°±17.5°. Major curves that were corrected by 38.7±22.1% in the bending radiograms, postoperatively achieved a correction of 64.0±15.8%. At the last follow-up visit, 10.3°±10.8° of correction loss was recorded in major curves in the frontal plane with 50.5±23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7°±7.4°, 37.0°±8.4°, 37.5°±8.7°, and 36.3°±8.5°, respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9° and 12.9° for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively. Postoperatively, a statistically significant correction was obtained in LT, SH, and SS values (P<0

  5. Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

    SciTech Connect

    Jereczek-Fossa, Barbara Alicja . E-mail: barbara.fossa@ieo.it; Santoro, Luigi; Alterio, Daniela; Franchi, Benedetta; Fiore, Maria Rosaria; Fossati, Piero; Kowalczyk, Anna; Canino, Paola; Ansarin, Mohssen; Orecchia, Roberto

    2007-06-01

    Purpose: Fatigue is an underevaluated cancer-related and treatment-related symptom. We analyzed fatigue in head and neck cancer patients undergoing radiotherapy (RT). Methods and Materials: A total of 117 patients were enrolled (mean age, 58 years). Radiation therapy (median dose, 66 Gy) was given with either exclusive or postoperative intent in 52 and 65 patients, respectively. Chemotherapy (CT) was added before and/or during RT in 61 patients. The patients completed a 20-item questionnaire (Multidimensional Fatigue Inventory [MFI-20]) before, during (weekly), and after RT. The impact of patient-, tumor-, and treatment-related factors on fatigue was evaluated with unifactorial and multifactorial tests. Results: Fatigue level increased during RT reaching a maximum at Week 6 and then slowly decreased. In multivariate stepwise regression analysis age (inversely related, p < 0.05), psychologic disorders (p < 0.005), and previous head-and-neck surgery (inversely related, p < 0.005) were correlated with higher pre-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p = 0.035), need of cortisone during RT (p = 0.005), and thyroid disorders (p = 0.032) were correlated with higher during-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p < 0.001), and need of cortisone during RT (p < 0.005) were correlated with higher post-RT fatigue level. No impact of gender, performance status, comorbidities other than psychologic and thyroid, tumor stage/site, RT intent, dose, volume, duration, or toxicity was observed. Conclusion: Fatigue affects all patients undergoing RT for head-and-neck cancer, reaches maximum score at the 6th week of RT, and slowly decreases thereafter. Age, thyroid dysfunction, psychologic disorders, pre-RT fatigue score, CT, and cortisone use are correlated with RT-related fatigue levels.

  6. Secondary alveolar bone grafting using milled cranial bone graft: a retrospective study of a consecutive series of 100 patients.

    PubMed

    Denny, A D; Talisman, R; Bonawitz, S C

    1999-03-01

    The purpose of this study was to evaluate the outcome of secondary bone grafting of alveolar clefts using milled cranial bone graft. The study included a consecutive series of 100 patients who were operated on between 1986 and 1995 by a single senior surgeon. The patients were divided into four groups; (1) unilateral alveolar cleft or (2) bilateral alveolar cleft, (3) before eruption of the canine teeth or (4) after eruption. Follow-up ranged from a minimum of 12 months to 10 years, and evaluation included a physical examination, medical photography, orthodontic reports, and a panorex X-ray and/or a three-dimensional computed tomography scan of the maxilla produced using Denta-scan software. Patient outcomes were judged to be good, acceptable, or poor. Patients who developed any fistula or required regrafting were defined as poor outcomes. The combined good and acceptable outcomes represented 83% of the entire consecutive series. These two groups were defined as successful outcomes. In patients with unilateral and bilateral clefts who were under 12 years old, the success rate was 90% and 88%, respectively. In patients grafted following full canine eruption (>12 years old), success rate decreased to 83% in patients with unilateral and 66% in bilateral clefts, respectively. Our results support the use of milled cranial bone graft, which produces a stable closure of the alveolar cleft with good contour and support for adjacent tooth eruption. Our data further support the conclusion by others that outcomes of early secondary grafting are superior to delayed grafting. The experience presented here, including the success rate, ease of harvesting, and minimal morbidity, makes the cranium our preferred donor site for alveolar cleft grafting.

  7. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique.

    PubMed

    Modi, Hitesh N; Suh, Seung Woo; Fernandez, Harry; Yang, Jae Hyuk; Song, Hae-Ryong

    2008-12-01

    It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve <90 degrees ) and 69% in group 2 (curve >90 degrees) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

  8. The Günther-Tulip retrievable IVC filter: clinical experience in 118 consecutive patients.

    PubMed

    Ota, Satoshi; Yamada, Norikazu; Tsuji, Akihiro; Ishikura, Ken; Nakamura, Mashio; Isaka, Naoki; Ito, Masaaki

    2008-02-01

    The purpose of this study was to assess the use of the Günther Tulip Filter (GTF) for the management of venous thromboembolism (VTE). Between December 2000 and April 2005, 118 patients (42 males, 76 females; mean age 60.5 years) diagnosed with VTE, underwent treatment with a GTF. The filter was left permanently in 52 patients. In the other 66 patients, attempts were made to retrieve it, with success in 60 cases (90.9%). No major complication was found throughout the filter's use. Of the 58 patients with the permanent filters, 41 underwent enhanced computed tomography at follow-up in the chronic phase. Thirty-eight filters (92.7%) remained patent, and under low-intensity anticoagulation therapy (international normalized ratio 1.8+/-0.4), the patency rate was 97.1%. Penetration of the inferior vena cava (IVC) wall by the filter's struts beyond a distance of 3 mm occurred in 23 patients (56.1%), but there was no observable leakage from the IVC or injury to adjacent organs. The GTF is feasible and safe for treating VTE. When used permanently, GTFs have a high patency rate, and there is neither leakage from the IVC nor injury to adjacent organs in the event of penetration by the struts.

  9. Animal models of scoliosis.

    PubMed

    Bobyn, Justin D; Little, David G; Gray, Randolph; Schindeler, Aaron

    2015-04-01

    Multiple techniques designed to induce scoliotic deformity have been applied across many animal species. We have undertaken a review of the literature regarding experimental models of scoliosis in animals to discuss their utility in comprehending disease aetiology and treatment. Models of scoliosis in animals can be broadly divided into quadrupedal and bipedal experiments. Quadrupedal models, in the absence of axial gravitation force, depend upon development of a mechanical asymmetry along the spine to initiate a scoliotic deformity. Bipedal models more accurately mimic human posture and consequently are subject to similar forces due to gravity, which have been long appreciated to be a contributing factor to the development of scoliosis. Many effective models of scoliosis in smaller animals have not been successfully translated to primates and humans. Though these models may not clarify the aetiology of human scoliosis, by providing a reliable and reproducible deformity in the spine they are a useful means with which to test interventions designed to correct and prevent deformity.

  10. Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample.

    PubMed

    De la Garza Ramos, Rafael; Goodwin, C Rory; Abu-Bonsrah, Nancy; Jain, Amit; Miller, Emily K; Huang, Nicole; Kebaish, Khaled M; Sponseller, Paul D; Sciubba, Daniel M

    2016-12-01

    OBJECTIVE The aim of this study was to investigate the incidence of and factors associated with complications following idiopathic scoliosis surgery in adolescents. METHODS The Nationwide Inpatient Sample database was used to identify patients 10-18 years of age who had undergone spinal fusion for adolescent idiopathic scoliosis (AIS) from 2002 to 2011. Twenty-three unique in-hospital postoperative complications, including death, were examined. A series of logistic regressions was used to determine if any demographic, comorbid, or surgical parameter was associated with complication development. Results of multiple logistic regression analyses were reported as odds ratios with 95% confidence intervals. All analyses were performed after the application of discharge weights to produce national estimates. RESULTS A total of 36,335 patients met the study inclusion criteria, 7.6% of whom (95% CI 6.3%-8.9%) developed at least one in-hospital complication. The 3 most common complications were respiratory failure (3.47%), reintubation (1.27%), and implant related (1.14%). Major complications such as death, pancreatitis, disseminated intravascular coagulation, visual loss, spinal cord injury, cardiac arrest, sepsis, nerve root injury, deep vein thrombosis, pulmonary embolism, shock, malignant hyperthermia, myocardial infarction, and iatrogenic stroke each had an incidence ≤ 0.2%. On multiple logistic regression analysis, an increasing age (OR 0.80) was associated with significantly lower odds of complication development; patients who were male (OR 1.80) or who had anemia (OR 2.10), hypertension (OR 2.51), or hypothyroidism (OR 2.27) or underwent revision procedures (OR 5.55) were at a significantly increased risk for complication development. The rates of postoperative complications for posterior, anterior, and combined approaches were 6.7%, 10.0%, and 19.8%, respectively (p < 0.001). Length of fusion (< 8 vs ≥ 8 levels) was not associated with complication development

  11. Discrepancy between radiographic shoulder balance and cosmetic shoulder balance in adolescent idiopathic scoliosis patients with double thoracic curve

    PubMed Central

    Qiu, Xu-sheng; Ma, Wei-wei; Li, Wei-guo; Wang, Bin; Yu, Yang; Zhu, Ze-zhang; Qian, Bang-ping; Zhu, Feng; Sun, Xu; Ng, Bobby K. W.; Cheng, Jack C. Y.

    2008-01-01

    Shoulder balance is one of the key components to the body deformity in adolescent idiopathic scoliosis (AIS) patients with double thoracic curve and shoulder cosmesis plays an important role in patients’ satisfaction of surgical outcomes. Up to now, only radiographic parameters were used to evaluate the shoulder balance in literatures; no corresponding cosmetic parameters have been developed to evaluate the cosmetic shoulder balance. Meanwhile, we often confronted that perfect radiographic shoulder balance was achieved, but the patients complained about the residual cosmetic deformity. This phenomenon implied that discrepancy may exist between radiographic shoulder balance and cosmetic shoulder balance. The present study was carried out to investigate the correlation between radiographic and clinical cosmetic shoulder balance in AIS patients with double thoracic curve. Thirty-four AIS patients were recruited for this study. All the patients had a double thoracic curve. Six cosmetic parameters––inner shoulder height (SHi), outer shoulder height (SHo), shoulder area index 1 (SAI1), shoulder area index 2 (SAI2), shoulder angle (α1) and axilla angle (α2) were developed and measured on the standing photographs. Also, seven radiographic parameters––T1 tilting (T1), first rib angle (FRA), clavicle angle (CA), coracoid process height (CPH), clavicle-rib cage intersection (CRCI), first rib–clavicle height (FRCH), trapezius length (TL) were measured on the standing posterior–anterior radiographs. Correlation analysis was made between cosmetic parameters and radiographic parameters. SHi was found to be significantly correlated with T1, FRA, CA, CPH, CRCI (P < 0.05), among which FRA had the highest correlation coefficient. SHo was found to be significantly correlated with T1, FRA, CA, CPH, CRCI, FRCH (P < 0.05), among which CRCI had the highest correlation coefficient. However, none of the correlation coefficient was greater than 0.8. The correlation

  12. A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery

    PubMed Central

    Sharma, Ashima; Yadav, Monu; Kumar, B. Rajesh; Lakshman, P. Sai; Iyenger, Raju; Ramchandran, Gopinath

    2016-01-01

    Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid–base changes, hemodynamics, and readiness for extubation during scoliosis surgery. Subjects and Methods: Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL (n = 15) or SF (n = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit. Results: There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF. Conclusions: SF-infused patients had nonremarkable changes in acid–base physiology in scoliosis surgery. PMID:27746547

  13. Clinical Course and Management of a Consecutive Series of Patients with “Healed Temporal Arteritis”

    PubMed Central

    Lee, Yvonne C.; Padera, Robert F.; Noss, Erika H.; Fossel, Anne H.; Bienfang, Don; Liang, Matthew H.; Docken, William P.

    2012-01-01

    Objectives 1) To describe the clinical course and management of patients with a pathologic diagnosis of “healed” giant cell arteritis; 2) To determine if previously published histological descriptions of healed arteritis can identify patients with a greater likelihood of clinically significant arteritis. Methods All temporal artery biopsy reports between 1994 and 2003 were examined for a diagnosis of “healed arteritis.” Two rheumatologists abstracted the medical record for presenting features, physical findings, co-morbid conditions and data on treatment and outcomes. One pathologist, blinded to the clinical data, reviewed all specimens and re-interpreted the biopsies according to published histological descriptions of healed arteritis. Results Forty-seven patients with an initial pathologic diagnosis of healed arteritis were identified. In 54% of these patients, corticosteroid therapy did not change after the diagnosis of healed arteritis was documented in the pathology report. Seventy percent were ultimately treated with no corticosteroids or low-moderate corticosteroid regimens. Only 32% of the initial cases were confirmed upon review of the biopsies using standardized histological criteria. Patients with confirmed healed arteritis were more likely to have a documented history of polymyalgia rheumatica/giant cell arteritis and a longer duration of steroid treatment before biopsy. These patients were not more likely to have adverse outcomes. Conclusion In this case series, the diagnosis of healed arteritis had little impact on treatment decisions. In most cases, the initial pathologic diagnosis of healed arteritis was not confirmed when biopsies were reviewed by a single pathologist using uniform histological criteria. PMID:22133620

  14. Chiari-related hydrocephalus: assessment of clinical risk factors in a cohort of 297 consecutive patients.

    PubMed

    Guan, Jian; Riva-Cambrin, Jay; Brockmeyer, Douglas L

    2016-11-01

    OBJECTIVE Patients treated for Chiari I malformation (CM-I) with posterior fossa decompression (PFD) may occasionally and unpredictably develop postoperative hydrocephalus. The clinical risk factors predictive of this type of Chiari-related hydrocephalus (CRH) are unknown. The authors' objective was to evaluate their experience to identify risk factors that may predict which of these patients undergoing PFD will develop CRH after surgery. METHODS The authors performed a retrospective clinical chart review of all patients who underwent PFD surgery and duraplasty for CM-I at the Primary Children's Hospital in Utah from June 1, 2005, through May 31, 2015. Patients were dichotomized based on the need for long-term CSF diversion after PFD. Analysis included both univariate and multivariable logistic regression analyses. RESULTS The authors identified 297 decompressive surgeries over the period of the study, 22 of which required long-term postoperative CSF diversion. On multivariable analysis, age < 6 years old (OR 3.342, 95% CI 1.282-8.713), higher intraoperative blood loss (OR 1.003, 95% CI 1.001-1.006), and the presence of a fourth ventricular web (OR 3.752, 95% CI 1.306-10.783) were significantly associated with the need for long-term CSF diversion after decompressive surgery. CONCLUSIONS Younger patients, those with extensive intraoperative blood loss, and those found during surgery to have a fourth ventricular web were at higher risk for the development of CRH. Clinicians should be alert to evidence of CRH in this patient population after PFD surgery.

  15. [Radio frequency of atrial fibrillation: results from 102 consecutive patients--secondary publication].

    PubMed

    Pontoppidan, Jacob; Nielsen, Jens Cosedis; Poulsen, Steen Hvitfeldt; Mortensen, Peter Thomas; Pedersen, Anders Kirstein; Jensen, Henrik Kjaerulff; Hansen, Peter Steen

    2006-01-30

    Segmental pulmonary vein isolation (SPVI) and circumferential pulmonary vein isolation (CPVI) are the two main approaches to radiofrequency ablation in patients with atrial fibrillation (AF). The aim of this retrospective study was to investigate the safety level and patient outcome of both approaches. The overall freedom from symptoms was 73% and 25% after CPVI and SPVI, respectively. Our study concludes that CPVI is an effective treatment of highly symptomatic and drug-resistant AF and when used in laboratories by experienced electrophysiologists has a promising and reproducible outcome ratio and safety level.

  16. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: five-year update on a previously published cohort.

    PubMed

    Ramo, Brandon A; Richards, B Stephens

    2012-06-15

    A retrospective case series. To identify the overall reoperation rate and factors contributing to reoperation in a recent 5-year cohort of patients (2003-2007) undergoing spinal deformity surgery. These patients were compared with a previously published 15-year cohort of consecutive patients (1988-2002) from the same institution to assess for any significant differences in reoperation rates. In a previously published report from this institution, the reoperation rate for patients with idiopathic scoliosis treated during a 15-year period (1988-2002) was 12.9%. That group was predominantly treated with first-generation TSRH (Medtronic, Memphis, TN) implants and CD implants. Lower profile, more rigid implant systems are now used along with refined techniques for correction of scoliosis deformity. We hypothesized that these factors would lead to lower rates of reoperation. METHODS.: The medical records of 452 consecutive patients (older than 9 yr) surgically treated for idiopathic scoliosis at one institution during 5 years (2003-2007) were reviewed to identify those who required reoperation. The reoperation rate for this cohort was 7.5% (34 of 452 patients). Compared with the prior cohort, significant decreases were noted with regard to total reoperation rate as well as reoperation due to infection and pseudarthrosis. Trends were noted toward decreased rates of reoperation due to prominent implants, dislodged implants, and implant proximity to vital structures. Within the newer cohort, a trend toward decreased reoperation rate was also noted for lower profile implant systems compared with first-generation TSRH implants. With the evolution of newer lower profile segmental implant systems that provide more rigid fixation and with the advancements in techniques for deformity correction, the repeat surgical intervention rate for idiopathic scoliosis has decreased.

  17. Laparoscopic splenectomy in patients with hereditary spherocytosis: report on 12 consecutive cases.

    PubMed

    Vecchio, R; Intagliata, Eva; Ferla, F; Marchese, S; Cacciola, R R; Cacciola, E

    2013-12-01

    Hereditary spherocytosis is an inherited hemolytic anemia caused by a deficiency in erythrocyte membrane proteins. Removal of the spleen may reduce the intra-splenic hemolytic process of the disease and, therefore, may correct the anemia. Furthermore, it seems to decrease the levels of serum bilirubin, thus reducing the formation of gallbladder stones. Indications and timing of splenectomy, however, are still debated. Twelve patients with severe hereditary spherocytosis operated on with laparoscopic splenectomy were retrospectively reviewed. Median age at diagnosis was 13.8 years (range 8-25 years). Male to female ratio was 5/7. Indications for laparoscopic removal of the spleen included anemia unresponsive to iron supplementation in eight patients (66.6 %) with increase need for red cells transfusions, and jaundice with symptoms related to cholelitiasis in four patients (33.3 %). Laparoscopic splenectomy was associated in four cases to laparoscopic cholecystectomy. Mean operative time was 50 min (range 40-75 min) with no conversion to open surgery. Mean hospital stay ranged from 3 to 7 days. In a 16-month follow-up, no complications were recorded and a persistent correction of anemia was observed. With the advent of laparoscopic surgery, splenectomy has been performed by this mini-invasive approach in referral centers. Laparoscopic splenectomy is an effective technique, when performed in patients with hereditary spherocytosis. Low complication rate and persistent correction of the hematologic disorders can be expected after the laparoscopic splenectomy, provided that a proper technique is performed and an experienced surgical team is available.

  18. 22q11.2 Deletions in Patients with Conotruncal Defects: Data from 1610 Consecutive Cases

    PubMed Central

    Peyvandi, Shabnam; Lupo, Philip J; Garbarini, Jennifer; Woyciechowski, Stacy; Edman, Sharon; Emanuel, Beverly S; Mitchell, Laura; Goldmuntz, Elizabeth

    2013-01-01

    Background The 22q11.2 deletion syndrome is characterized by multiple congenital anomalies including conotruncal cardiac defects. Identifying the patient with a 22q11.2 deletion (22q11del) can be challenging because many extracardiac features become apparent later in life. We sought to better define the cardiac phenotype associated with a 22q11del to help direct genetic testing. Methods 1,610 patients with conotruncal defects were sequentially tested for a 22q11del. Counts and frequencies for primary lesions and cardiac features were tabulated for those with and without a 22q11del. Logistic regression models investigated cardiac features that predicted deletion status in tetralogy of Fallot (TOF). Results Deletion frequency varied by primary anatomic phenotype. Regardless of the cardiac diagnosis, a concurrent aortic arch anomaly (AAA) was strongly associated with deletion status (OR 5.07, 95% CI: 3.66–7.04). In the TOF subset, the strongest predictor of deletion status was an AAA (OR 3.14, 95% CI: 1.87–5.27, p <0.001), followed by pulmonary valve atresia (OR 2.03, 95% CI: 1.02–4.02, p= 0.04). Among those with double outlet right ventricle and transposition of the great arteries, only those with an AAA had a 22q11del. However, five percent of patients with an isolated conoventricular ventricular septal defect and normal aortic arch anatomy had a 22q11del, while no one with an IAA-A had a 22q11del. Conclusion A subset of patients with conotruncal defects are at risk for a 22q11del. A concurrent AAA increases the risk regardless of the intracardiac anatomy. These findings help direct genetic screening for the 22q11.2 deletion syndrome in the cardiac patient. PMID:23604262

  19. Morphological features of the left atrial appendage in consecutive coronary computed tomography angiography patients with and without atrial fibrillation

    PubMed Central

    Parkkonen, Johannes; Hedman, Marja; Muuronen, Antti; Onatsu, Juha; Mustonen, Pirjo; Vanninen, Ritva; Taina, Mikko

    2017-01-01

    The majority of intracardiac thrombi form in the left atrial appendage (LAA). Enlargement of this structure, together with certain morphological features, may indicate a predisposition to the formation of thrombi and subsequent cardioembolic stroke. Thus far, studies on LAA morphology have largely focused on those patients with atrial fibrillation (AF). Taking a different approach, we investigated the variation in LAA morphology in a consecutive patient population with and without AF. We evaluated 808 consecutive patients (529 females; mean age 52.5±9.9 years) who underwent coronary artery computed tomography angiography (CCTA), the majority of whom (749) had no history of AF. We assessed the length, lobe number, and morphological classification of their LAAs. Demographic data and medical histories were collated from medical records and then correlated with LAA morphology. The proportions of each of the four morphological classes of LAA for the overall vs. non-AF population were: WindSock, 62.3/61.5%; Cactus, 18.6/18.8%; ChickenWing, 10.0/10.0%; and CauliFlower, 9.2/9.6%. Age (p<0.001; r = 0.156) and female gender (p<0.001) were both found to be associated with an increased body surface area (BSA)-related LAA length. Male patients were more likely to manifest multi-lobed (p = 0.003) LAAs, and overweight patients with a greater number of multi-lobed LAA morphological classes (p = 0.010). No associations with morphological LAA features could be found for patients with diabetes, hypertension, or dyslipidemia. Nor did the size of the left atrium exhibit any correlation with BSA-related LAA length. In the overall and non-AF populations, aging and female gender were associated with longer BSA-indexed LAAs. PMID:28288200

  20. Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with “U” Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Zhang, Shaobo; Lian, Qingquan; Yan, Haibo; Lin, Xianfa

    2017-01-01

    The objective was to report a case of a 63-year-old man with a history of low back pain (LBP) and left leg pain for 2 years, and the symptom became more serious in the past 5 months. The patient was diagnosed with lumbar scoliosis combined with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) at the level of L4-5 that was confirmed using Computerized Topography and Magnetic Resonance Imaging. The surgical team preformed a novel technique, “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD), which led to substantial, long-term success in reduction of pain intensity and disability. After removing the osteophyte mass posterior to the thecal sac at L4-5, the working channel direction was changed to the gap between posterior longitudinal ligament and thecal sac, and we also removed the herniation and osteophyte at L3-4 with “U” route PELD. The patient's symptoms were improved immediately after the surgical intervention; low back pain intensity decreased from preoperative 9 to postoperative 2 on a visual analog scale (VAS) recorded at 1 month postoperatively. The success of the intervention suggests that “U” route PELD may be a feasible alternative to treat lumbar scoliosis with LSS and LDH patients. PMID:28203471

  1. Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients.

    PubMed

    Street, John T; Lenehan, Brian J; DiPaola, Christian P; Boyd, Michael D; Kwon, Brian K; Paquette, Scott J; Dvorak, Marcel F S; Rampersaud, Y Raja; Fisher, Charles G

    2012-01-01

    To date, most reports on the incidence of adverse events (AEs) in spine surgery have been retrospective and dependent on data abstraction from hospital-based administrative databases. To our knowledge, there have been no previous rigorously performed prospective analysis of all AEs occurring in the entire population of patients presenting to an academic quaternary referral center. To determine the mortality and true incidence and severity of morbidity (major and minor, medical and surgical) in adults undergoing complex spinal surgery, both trauma and elective, in a quaternary referral center. To examine the influence of the introduction of a dedicated weekly multidisciplinary rounds, and a formal abstraction tool, on the recording of this prospective perioperative morbidity data. To examine the validity and inter- and intraobserver reliability of a dedicated Spine AdVerse Events Severity system, version 2 (SAVES