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 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied the functional outcome of spinal fusion for the surgical treatment of scoliosis in 8 patients with Duchenne muscular dystrophy (DMD). The mean age of DMD patients at the time of the surgery and the mean follow-up duration was 13.8 (12.3 to 15.4) and 3.9 (1.5 to 6.8) years, respectively. The average spinal angle (Cobb angle) was corrected from 58.8 to 28.6 degrees with the mean corrective rate of 51.3% by the surgical intervention. The correction rate was higher and the corrected Cobb angle remained unchanged during follow-up period in mildly scoliotic patients. Forced vital capacity (FVC) increased post-operatively in 3 patients with moderate scoliosis (Cobb angle: 50 to 80 degrees), indicating that the correction of spinal alignment is effective for the treatment of decreased thoracic volume in DMD. On the other hand, two cases with low % FVC (16.9% and 30.4%, respectively) had poor prognosis in respiratory status. Namely, one died of pneumonia at 17 months after the surgery and the other required mechanical ventilation via nasal mask at 3 years post surgery. Sitting balance improved in all patients, which resulted in more functional use of their upper extremities. During the follow-up period, all patients except one patient who died of pneumonia could maintain sitting balance without support. Moreover these included 2 patients over 20 year old. No complications related to spinal deformities have been found in these patients. Previous study in our hospital showed that 7 of 48 (14.6%) of DMD patients spent all their lives without apparent scoliosis (Cobb angle less than 30 degrees). These suggest that spinal fusion could be recommended for patients with Cobb angle more than 30 degrees and with % FVC more than 35%. Although the impact of spinal fusion upon the life expectancy remains unclear, favorable effect on respiratory function and quality of life can be expected for carefully selected patients with DMD.
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PMID:[The effects of spinal fusion on respiratory function and quality of life in Duchenne muscular dystrophy]. 916 37

Thoracoscopic diskectomy has been described in adults as an alternative to thoracotomy for access to the anterior spine for correction of scoliosis, but its use in children for correction of spinal deformities has not been reported. Eight patients have undergone video-assisted thoracoscopic diskectomy with fusion before posterior instrumentation. In five patients, the posterior fusion and instrumentation followed the thoracoscopic procedure under the same anesthesia; in three patients it was staged and performed 1 week later. The mean time required for the thoracoscopic procedure was 174 minutes. Intraoperative bleeding requiring transfusion developed in one patient. No other complications occurred. The authors conclude that the minimally invasive approach for access to the thoracic cavity for anterior diskectomy and fusion will be the preferred approach because of the potential for significant reduction in postoperative discomfort and complications such as atelectasis and pneumonia. Postoperative hospitalization may not be decreased, however, because the patient must still recover from the open posterior instrumentation and fusion operation.
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PMID:Video-assisted thoracoscopic diskectomy and fusion. 924 47

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. New means of treating scoliosis have become established and should be understood by the radiologist. To the well-known postoperative complications, including pneumothorax, pneumonia, and gastrointestinal obstruction, are added new specific potential problems with the new surgical methodology.
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PMID:Scoliosis circa 2000: radiologic imaging perspective. II. Treatment and follow-up. 992 25

Patients with developmental disorders, including adolescents, comprise a large and heterogeneous group of individuals who vary in underlying diagnosis and degree of disability. The largest numbers of patients are those with cerebral palsy and with traumatic brain injury. While these conditions themselves do not directly cause airway or parenchymal lung dysfunction, consequences of neuromuscular dysfunction, especially aspiration and ineffective cough, may lead to lung damage. Poor nutritional status, impairment of airway clearance by muscular weakness or incoordination and poor pulmonary reserve (due to chest wall or spine deformity) increase the risk of significant morbidity and mortality from respiratory infections. Individuals who were premature infants or who had prolonged neonatal courses may also have residual chronic lung disease (bronchopulmonary dysplasia) contributing to their pulmonary problems. This review discusses conditions that have adverse effects on the airway and lung (drooling, feeding problems, gastroesophageal reflux, aspiration, spasticity, scoliosis) and some of the consequences of these insults (disordered airway clearance, pneumonia, sleep apnea). Also discussed are issues important to the prevention or amelioration of respiratory difficulties, including preventive care, the effects of exercise, dental hygiene, and surgical intervention.
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PMID:Respiratory problems in the adolescent with developmental delay. 1106 May 58

Trichobezoars are masses of entangled material, found in the stomach and intestines, composed of hair ingested by the patient. When the mass grows, symptoms of intestinal occlusion can appear. Trichobezoars in pediatrics are usually found in adolescent females presenting personality disorders and trichophagia. This work describes a case of trichobezoar diagnosed in a 13 year-old girl, wearing a brace for serious scoliosis but absolutely normal from the emotional and psychical point of view, with normal scholastic and familiar situation. Already hospitalized three months before for pneumonia from mycoplasma, the girl comes to our observation for the appearance of vomiting and constipation. The clinical examination reveal an epigastric mass as big as an orange. General conditions and hematochemical tests are good. Lab tests are performed (abdomen echography and upper abdomen MNR) but is the oesophago-gastroscopy which allows the diagnosis. A big trichobezoar is then surgically removed and the gastroenteric symptoms completely disappear.
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PMID:[Obstructive syndrome caused by trichobezoars: historical disease or disease still current? Description of a case in adolescence]. 1126 31

The results of operative treatment of scoliosis in Down syndrome at one institution are reviewed. Seven patients with progressive scoliosis who had undergone arthrodesis of the thoracolumbar spine were identified. Clinical and radiographic results were noted, as were any complications. Mean patient follow up was 9 years (range 2-25). All patients eventually showed radiographic evidence of solid fusion with no curve progression. One patient had undergone a revision procedure for pseudoarthrosis and failure of Dwyer instrumentation. Other complications included a lateral subluxation under the fusion area, pneumonia, and one asymptomatic hook dislodgment. Progressive deformities of the thoracolumbar spine in Down syndrome patients can be treated with fusion and instrumentation with cessation of progression. As is the case for upper cervical fusion in these patients, the complication rate is notable.
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PMID:Spinal arthrodesis for scoliosis in Down syndrome. 1260 43

Atelectasis is a common respiratory complication in patients with severe motor and intellectual disabilities. We encountered 3 patients with irreversible atelectasis due to delayed therapy, emphasizing the necessity of performing flexible bronchofiberscopy. A total of 21 patients with atelectasis were studied to assess the etiology and efficacy of bronchofiberscopy. The underlying condition was bronchitis/pneumonia in 19 cases, tracheal hemorrhage in 1, and lung cancer in 1. Most of the patients had predisposing factors, such as a bedridden status in 90% and a weak or absent cough reflex in 81%. It was statistically suggested that atelectasis is likely to occur on the side contralateral to thoracic scoliosis. Among the 18 patients who underwent bronchofiberscopy within 2 weeks after the diagnosis of atelectasis, 16 (89%) showed recanalization and resultant improvement of respiratory failure. Bronchofiberscopy is useful for treating atelectasis in patients with severe motor and intellectual disabilities.
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PMID:[Etiology and bronchofiberscopic treatment of pulmonary atelectasis in patients with severe motor and intellectual disabilities]. 1527 14

We compared children who were hospitalized for the management of idiopathic scoliosis (IS) and neuromuscular scoliosis (NMS) via analysis of the 2000 Healthcare Cost and Utilization Project Kid Inpatient Database. Children with NMS had longer lengths of stay (9.2 vs. 6.1 days, P < 0.001), higher total charges (66,953 US dollars vs. 47,463 US dollars, P < 0.001), more diagnoses (6.3 vs. 2.5, P < 0.001), and more total procedures (4.2 vs. 3.0, P < 0.001) than did children with IS. Children with NMS more frequently developed pneumonia (3.5% vs. 0.7%, P < 0.001), respiratory failure (24.1% vs. 9.2%, P < 0.001), urinary tract infections (5.3% vs. 0.7%, P < 0.001), and surgical wound infections (1.3% vs. 0.3%, P < 0.001). Overall, 1570 children with NMS underwent spinal surgery, totaling to 105 US dollars million in hospital charges and 14,444 hospital days. We conclude that children with NMS experience significantly more complicated and costly hospitalizations than do children with IS. These results may add information on preoperative care, surgical decision-making, discussions of informed consent, and the provision of anticipatory guidance for children and their caregivers.
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PMID:Spinal surgery in children with idiopathic and neuromuscular scoliosis. What's the difference? 1655 38

In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0-17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.
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PMID:[Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. 1751 53

Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. Because most children are not imaged prior to onset of clinical symptoms, the appearance of early Mycoplasma infection has not been extensively studied. We present the case of an 11-year-old boy with large pulmonary masses incidentally detected during spine MRI evaluation for scoliosis. Eight days later, the patient developed acute respiratory symptoms, and the masses seen previously had evolved into a diffuse bronchiolitis. Diagnostic testing identified Mycoplasma pneumoniae as the likely etiology. We briefly review chest CT findings of infection by Mycoplasma and compare them to this unusual presentation of Mycoplasma pneumonia with subclinical imaging findings.
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PMID:Early Mycoplasma pneumoniae infection presenting as multiple pulmonary masses: an unusual presentation in a child. 1817 36


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