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Query: UMLS:C0700208 (scoliosis)
 8,574 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results are reported of domiciliary cuirass respirator treatment, using tailor-made shells, in four patients with severe thoracic scoliosis. Three of the patients had suffered from poliomyelitis. All complained of increasing dyspnoea on exertion, ultimately interfering with almost every activity of daily life; three patients had severe acute respiratory failure necessitating urgent admission to the Respiratory Care Unit. Right heart failure was present in two. Two patients required mechanical treatment via an endotracheal tube. All the patients were discharged home with a cuirass respirator. Standard type shells were used initially with low efficiency due to the poor fit of the cuirass shell to the deformed thoracic cage. Tailor-made shells were constructed from polyester reinforced with glass fibre, modelled on plaster casts of the thoracic cage. Subjectively the patients improved greatly and were able to resume and increase many activities. One patient committed suicide for reasons unconnected with treatment but the other three patients have been doing well from the time the cuirass respirator treatment was started, respectively, 3, 6, and 10 years ago. This treatment seems particularly effective in younger patients with severe paralytic scoliosis and cardiorespiratory failure, although the possibility of using it in older patients suffering from scoliosis of other aetiology should certainly be explored.
Thorax 1977 Apr
PMID:Cuirass respirator treatment of chronic respiratory failure in scoliotic patients. 26 63

Ten girls with adolescent idiopathic scoliosis were studied before and 17-23 months after spinal fusion. None had any cardiac or respiratory disease complicating the scoliosis. They underwent a range of resting lung function tests and a progressive exercise test. The mean angle of scoliosis decreased from 65.8 to 27.3 degrees after operation but the only significant physiological benefit detected in this study was a decrease in the submaximal minute ventilation. The physiological benefit of spinal fusion was therefore much less prominent than the anatomical improvement of the spinal curvature.
Thorax 1979 Oct
PMID:Cardiac and respiratory function before and after spinal fusion in adolescent idiopathic scoliosis. 51 86

Cardiac catheterisation was carried out in 40 patients with thoracic scoliosis in order to measure the pulmonary artery pressure. Statistical correlations were calculated between these results and the electrocardiographic and mechanocardiographic findings determined on a separate occasion. The pulmonary artery pressure was normal in 72% of subjects. It was inversely correlated with arterial oxygen tension but not with the aetiology, severity, or age at onset of the scoliosis. The accuracy of electrocardiography and mechanocardiography in predicting the pulmonary artery pressure was assessed. The closet correlates were found to be a tall P wave in lead II or III and a prolonged interval between pulmonary valve closure and tricuspid valve opening.
Thorax 1977 Dec
PMID:A study of pulmonary artery pressure, electrocardiography, and mechanocardiography in thoracic scoliosis. 60 32

Twenty-six subjects with thoracic scoliosis due to various causes have been investigated. They all performed a progressive exercise test under standardised conditions, and their maximum oxygen uptake (VO2 max), blood gases, and ventilatory and heart rate responses were observed. The VO2 max was significantly below normal and was proportional to the forced expiratory volume in one second (FEV1) and maximum exercise ventilation (VE max). Exercise was limited by ventilatory factors in 80% of the subjects who exercised maximally. VE max was diminished, but the dyspnoeic index was normal. The minute ventilation (VE) at any given VO2 was about 20% greater than normal. This hyperventilation taken with the low VE max explains why exercise is usually ventilation-limited in these subjects. Tidal volume (VT) increased linearly with ventilation until VT max was reached. The tidal volumes at any given ventilation were less than normal, but when expressed as a percentage of vital capacity (VC) they were above normal. The heart rate increased more rapidly than normal, but this appears to be a physiological result of the small muscle mass of these subjects and not a pathological response.
Thorax 1978 Aug
PMID:The cardiorespiratory response to exercise in thoracic scoliosis. 69 97

Pulmonary artery catheterisation was carried out in 25 scoliotics aged 13 to 67 years (mean 30.7). Each then performed a progressive exercise test breathing air, and 11 performed a similar test breathing pure oxygen. The mean pulmonary artery pressure (PAP) increased linearly with oxygen uptake (VO2) and with the work rate. The pressure responses have been described in terms of ther intercept and rate of rise of pressure (sPAP/VO2 and sPAP/work rate). sPAP/VO2 was unrelated to the anatomical features of the scoliosis, or to PaO2. It was inversely related to vital capacity, functional residual capacity, and total lung capacity. Inspiration of pure oxygen lowered the resting pressure by a mean of 3.2 mmHg but only decreased sPAP/work rate by 9%. The maximum pressure reached during exercise was diminished by a mean of 5.2 mmHg when pure oxygen was breathed. The mean pressures were shown to fall exponentially after exercise. The time constants were proportional to sPAP/VO2 and to the final pressure reached during exercise. Inspiration of pure oxygen did not effect the time constants but decreased the post-exercise pressure load by lowering the final pressure during exercise.
Thorax 1978 Dec
PMID:Pulmonary artery pressure in thoracic scoliosis during and after exercise while breathing air and pure oxygen. 74 99

Severe idiopathic scoliosis may lead to respiratory failure, which can be treated by assisted ventilation. Twenty four patients with surgically untreated idiopathic scoliosis who had been examined in 1968 were re-examined in 1988 to assess changes in lung function and risk factors for respiratory failure. The patients were aged 15-67 years in 1968 and had a scoliotic angle of 10-190 degrees and a vital capacity of 1.0-6.0 litres. Spirometric values and scoliotic angles were determined in 1968 and 1988, and arterial blood gas tensions in 1988. The decline in spirometric values over the 20 years was of the same magnitude as the predicted decline due to aging. Arterial blood gas tensions in 1988 were strongly correlated with the scoliotic angles and spirometric indices recorded in 1968. Hypoxaemia and hypercapnia was seen in four patients in 1988 (then aged 43-67 years) and these were the four patients who had a vital capacity below 43% predicted in 1968. The remaining 20 patients had blood gas values within normal limits. Two further patients had died from respiratory failure before 1988, so a total of six patients had developed respiratory failure. In a multiple logistic analysis vital capacity expressed as % predicted in 1968 was the strongest predictor of the development of respiratory failure, followed by the scoliotic angle. Respiratory failure occurred only in patients who had a vital capacity below 45% predicted in 1968 and an angle greater than 110 degrees. Thus respiratory failure develops in adults with scoliosis with a large angle and a low vital capacity when normal aging reduces the ventilatory capacity further. Such individuals merit close follow up.
Thorax 1991 Jul
PMID:Lung function in adult idiopathic scoliosis: a 20 year follow up. 187 34

Nineteen survivors of congenital diaphragmatic hernia repair were compared with age and sex matched control children six to 11 years after repair. All subjects were examined clinically and underwent lung function testing. The patients also had individual lung volumes assessed radiographically and had radionuclide (krypton-81 m, technetium-99 m macroaggregates) ventilation-perfusion (V/Q) lung scans. Four patients had pectus excavatum and two had mild scoliosis. Spirometric measurements were lower in the patients than in the control subjects but only the differences in peak expiratory flow and flow at 50% of expired vital capacity were significant. The radiographic left lung volumes in patients surviving left diaphragmatic repair were larger than expected at 49.3% (SD 2%), suggesting alveolar overdistension. V/Q scans showed a mismatch in the ipsilateral lung, mean Q (40% (7%] being significantly lower than mean V (47% (6%)). In seven patients who had required ventilation for four days or more perfusion to the ipsilateral lung was significantly lower (34% (6%)) than values for the 12 patients ventilated for less than four days (43% (6%)). Survivors of right diaphragmatic repair had a better outcome in terms of relative radiographic lung volumes and V/Q distribution. More severely affected children are now surviving repair of congenital diaphragmatic herniation, with residual pulmonary abnormalities that could produce functional impairment in adult life.
Thorax 1990 Feb
PMID:Pulmonary sequelae in survivors of congenital diaphragmatic hernia. 231 75

Twenty eight subjects (mean age 64 years) who had been treated for tuberculosis by thoracoplasty in the past performed an increasing work rate exercise test, from which maximum oxygen consumption (VO2max), ventilation and heart rate were measured. VO2max was significantly lower than predicted, being 0.75 l/min in 17 subjects, 1.0 l/min in 10, and 1.5 l/min in one. Only one subject achieved a heart rate of 85% of the predicted maximum. The ratio of heart rate to oxygen consumption (HR/VO2) and heart rate at standard interpolated submaximal levels of oxygen uptake at 0.75 l/min (heart rate 0.75) and 1.0 l/min (heart rate 1.0) were normal. VO2max correlated with ventilation at maximal exercise (VE max) (r = 0.87) and FEV1 (r = 0.47). It did not correlate with resting arterial oxygen or carbon dioxide tensions, FEV1, maximum inspiratory pressure, angle of scoliosis, or number of ribs resected. The relation between ventilation and oxygen consumption (VE/VO2) and VE at the submaximal levels of oxygen consumption of 0.75 l/min (VE 0.75) and 1.0 l/min (VE 1.0) were normal. In 10 subjects a plateau of breathing frequency (fmax) was reached, after which the increase in ventilation was achieved by a further increase in tidal volume (VT). These subjects showed significantly lower values for the forced expiratory ratio, VO2max, and VEmax than those with a normal relation between tidal volume and breathing frequency. VEmax was correlated with FEV1 (r = 0.61), FVC (r = 0.46), maximum VT (r = 0.55), change in VT (r = 0.52), fmax (r = 0.56), and change in breathing frequency (r = 0.72). These results indicate that exercise in patients treated for tuberculosis by thoracoplasty is limited by ventilatory capacity and that this is due to a reduction in both dynamic lung volumes and respiratory frequency.
Thorax 1989 Apr
PMID:Exercise responses in patients treated for pulmonary tuberculosis by thoracoplasty. 276 28

The use of a corrective orthopaedic brace is an established form of management for patients with progressive idiopathic scoliosis. Thirteen patients with mild idiopathic scoliosis were studied with and without the corrective brace applied. Lung volumes and the pattern of chest wall and abdominal movement were measured during quiet breathing. Transdiaphragmatic pressures were measured in six of the patients and upper ribcage movement in seven patients. Application of the brace resulted in a significant reduction in vital capacity (14%), functional residual capacity (22%), and total lung capacity (12%). There was no effect on respiratory rate or minute volume. In the erect position the pattern of chest wall movement was altered with a reduction in lower ribcage movement of 46% and abdominal wall of 39% and an increase in upper ribcage movement of 43%. These changes were greater in the supine position. There was at least a twofold increase in end inspiratory and end expiratory gastric pressures during tidal breathing, but oesophageal pressures were not affected by the brace. Transdiaphragmatic pressures showed a similar twofold increase, which implies a substantial increase in the work of breathing. In view of the doubts concerning the influence of bracing on the natural history of idiopathic scoliosis and the substantial functional effect of bracing on the respiratory system, it is suggested that the current practice of bracing in this condition needs to be reviewed.
Thorax 1989 Jul
PMID:Effect of bracing on respiratory mechanics in mild idiopathic scoliosis. 277 55

The use of bracing in the treatment of mild idiopathic scoliosis is controversial. A study of 33 adolescents showed that bracing significantly decreased lung volumes. Functional residual capacity was reduced by a mean of 26%, 18% of children showing a reduction of greater than 40%. The mean reduction in total lung capacity was 16% and in forced vital capacity 18%. This restriction of lung function by bracing might have a deleterious effect on lung growth or might impose an additional risk factor in the presence of other disorders, such as asthma and diaphragmatic weakness. The use of bracing in individuals with mild scoliosis should be judiciously reassessed.
Thorax 1987 Dec
PMID:Pulmonary restrictive effect of bracing in mild idiopathic scoliosis. 343 84


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