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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.
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PMID:Cuirass respirator treatment of chronic respiratory failure in scoliotic patients. 26 63

We studied the pulmonary function and chest x-ray films of 20 nonsmokers with idiopathic prolapse of the mitral valve. Forty-five percent of these patients complained of dyspnea. Of the 16 chest films reviewed, 44 percent had radiographic evidence of pectus excavatum and 25 percent thoracic scoliosis. The most common pulmonary function abnormalities were increased residual volume (63 percent) and a reduced steady state diffusing capacity (50 percent of patients). There was no relationship between the presence of dyspnea and either chest wall deformity of abnormality of pulmonary function. These pulmonary function abnormalities may reflect a pulmonary parenchymal disorder possibly secondary to a connective tissue abnormality in the lung.
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PMID:Pulmonary function studies in patients with prolapse of the mitral valve. 44 65

Fifty-nine adult patients were examined who had undergone previous spine surgery for scoliosis but in whom pain (78 per cent), loss of correction (68 per cent), or dyspnea (36 per cent) subsequently developed. Twenty-six patients had idiopathic scoliosis, twenty-five had paralytic scoliosis secondary to poliomyelitis, and eight had scoliosis secondary to miscellaneous etiologies. A one-stage reconstructive procedure was performed in sixteen patients and a two-stage procedure, in forty-three patients. The two-stage procedure consisted of exposure of the spine and multiple osteotomies, followed by two weeks of halofemoral traction to obtain correction. The spine fusion was then extended, using Harrington instrumentation to maintain correction. At an average follow-up of 3.3 years there was reduction of pain in 67 per cent of the patients and a solid fusion in all but two. The complication rate was high (71 per cent), the most important complications being pseudarthrosis, wound infection, urinary tract infections, loss of lumbar lordosis, and pressure sores. The mortality rate was 3.4 per cent. No patient became paraplegic at the initial surgical procedure and early recognition and treatment of pseudarthrosis will reduce the number of patients requiring this salvage operation.
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PMID:Reconstructive surgery in the adult for failed scoliosis fusion. 51 76

Intrathoracic meningocele is regarded as an uncommon pathological entity frequently associated with von Recklinghausen's disease. In this paper, four cases of intrathoracic meningocele, treated between 1966 and 1986, are presented. There were three males and one female, all between the ages of 40 and 50. These were referred to our clinic for further evaluation of an asymptomatic lesion which had been seen on a routine chest roentgenogram. There was definite evidence of von Recklinghausen's disease in three cases: two males and one female. All four cases had no pain, dyspnea or neurological disorder. Chest and vertebral tomograms revealed masses in the posterior mediastinum and enlarged vertebral canals at the location of the lesion which varied from T-3 to T-11; three on the left side and one on the right side. None of them revealed scoliosis or kyphosis of the spine. In three cases, myelography was performed and showed an egg-shaped mass dorsolaterally. In two cases, metrizamide computed tomographic myelography was carried out and demonstrated deformity of the vertebral bone and passage of the contrast material through the enlarged vertebral canal into the paravertebral mass. Furthermore, magnetic resonance imaging was performed in two cases, and showed a homogeneous low signal intensity paravertebral mass communicating with the spinal canal on T1-weighted image. In two cases, the meningoceles were ligated or wrapped surgically. Postoperatively one presented a paraparesis and severe meningitis, and died; the other had an uneventful postoperative course. Two patients were followed conservatively without developing any symptoms or signs.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A report of four cases of intrathoracic meningocele]. 140 64

Rigid spine syndrome (RSS) is clinically characterized by progressive limitation of flexion of the spine and contractures of other joints. We herein report a 27-year-old man with RSS, who underwent tracheotomy because of severe restrictive respiratory failure. He had limitation of neck flexion and proximal muscle weakness from early childhood and was diagnosed as having muscular dystrophy at 16 years old. He was suffered from dyspnea and his first tracheotomy was performed at 24 years old. Two years later, the second tracheotomy was done because his respiratory failure was aggravated. He had limitation of spine flexion, scoliosis, but no limited range of elbow and wrist joints movement except mild contracture of ankle joints. Serum CK level was elevated to 590 IU/L. Repeated ECG examinations showed negative T wave but no conduction block. In his family, his parents and brother had neither similar clinical symptoms nor heart block. Chest X-ray study showed elevated diaphragm and enlarged heart shadow (CTR = 65%). Percent VC and FEV1 in sitting position were 14.6% and 100%, respectively. Arterial blood gas analysis showed PaO2 of 34.2 mmHg and PaCO2 of 77.2 mmHg. The density of paraspinal muscle in CT scan was severely decreased. Needle EMG showed myogenic change. Muscle biopsy from left biceps brachii showed myopathic change with mild type 2 fiber grouping. After the second tracheotomy, he was on a respiratory during sleep but mostly off in the daytime. His clinical features are different from Emery-Dreifuss muscular dystrophy because he had no heart conduction block and no family history, but progressive respiratory failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of rigid spine syndrome associated with severe respiratory failure]. 176 65

Clinical characteristics of 60 (41 males, 19 females) patients with echocardiographically proven mitral valve prolapse were analysed, with special interest in the associated thoracic skeletal abnormalities. There was a male preponderance (2.2:1) and 91.7% of patients were symptomatic--atypical chest pain, palpitations, exertional dyspnoea and easy fatiguability being the major symptoms. Sixty seven percent had an asthenic body habitus, and 55% had high-arched palate. Thoracic scoliosis (55%), straight back syndrome (50%), flat chest (46.7%), and pectus excavatum (20%) were seen in association with the condition, with 81.7% having any one or combination of these features. Lateral chest radiography showed pancaking of heart shadow in 48.3%. Isolated non-ejection systolic click(s) was the major cardiac auscultatory finding (61.7%), while 60% showed pansystolic prolapse on echocardiography. Electrocardiographic ST-T-U changes in the inferior and/or lateral chest leads were seen in 46.7%, while 16.7% had cardiac arrhythmias. None had infective endocarditis, heart failure or cerebral embolic events. The findings corroborate the view that thoracic skeletal anomalies may be regarded as non-auscultatory features of this syndrome.
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PMID:Mitral valve prolapse syndrome and associated thoracic skeletal abnormalities. 130 Oct 49

We measured lung function and exercise tolerance in 15 adults with moderate kyphoscoliosis (thoracic curvatures between 25 degrees and 70 degrees, mean +/- SD = 46.93 degrees +/- 14.02 degrees). Forced vital capacity showed a slight reduction from values predicted from age and sex matched control subjects (3.39 +/- 1.06 vs 4.06 +/- 0.82 L, p less than 0.05). However, exercise tolerance was significantly lower than previously reported in healthy adults (VO2max = 31.60 +/- 9.12 vs 37.07 +/- 4.91 ml/kg/min, p less than 0.05). Despite the reduced exercise tolerance, the ratio of maximum tidal volume to vital capacity (VTmax/VC) was similar to that observed in healthy adults. The mean dyspnea index (VEmax/MVV) was also normal at 69.4 +/- 19.0. Hypoxic and hypercapnic ventilatory responses were within predicted normal limits at 0.67 +/- 0.37 L/min-1 fall in SaO2-1 and 1.67 +/- 0.92 L/min-1 mm Hg PCO2(-1). We conclude that the impairment of exercise performance found in adults with moderate scoliosis cannot be attributed to any important ventilatory limitation, abnormality in lung volume, or impaired chemoreceptor sensitivity. We suggest that the reduced VO2max likely arises from deconditioning and lack of regular aerobic exercise.
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PMID:Impaired exercise capacity in adults with moderate scoliosis. 199 22

A retrospective survey was carried out on approximately 800 scoliotic subjects attending a chest clinic over 25 years. One hundred thirty-one patients with unfused idiopathic scoliosis were identified and further consideration was restricted to 54 who were assessed at 30 years of age or older. Sex, age of onset of curvature, severity at the time of presentation, degree of dyspnoea, presence of independent cardiac or pulmonary disease and smoking habit were recorded. Measurements of lung function were compared with predicted figures calculated according to span, age and sex. Disabling dyspnoea or cardiorespiratory failure were associated with either scoliosis of early onset (curve first noticed before 5 years) or with independent cardiac or pulmonary disease. Only one of 28 patients with unfused idiopathic scoliosis of adolescent onset developed disabling dyspnoea in later life attributable solely to spinal deformity. A similar conclusion was drawn from a separate survey of mortality in 86 patients, 19 of whom suffered from idiopathic scoliosis. Cardiorespiratory failure attributable to the scoliosis was the cause of death of 11 patients, in 10 of whom the curve had first been noticed at less than 5 years of age whereas the onset was during early adolescence (11 years) in only one.
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PMID:Cardiorespiratory consequences of unfused idiopathic scoliosis. 362 Mar 23

Adolescents with mild, asymptomatic scoliosis (thoracic curvature less than 35 degrees) may have little or no impairment of resting lung volumes. Progression to more severe disease may, however, be accompanied by lung restriction, impaired exercise tolerance, and respiratory failure with CO2 retention. We wished to see whether adolescents with mild scoliosis and minimally abnormal resting pulmonary mechanics had impairment of their responses to hypercapnia, hypoxia, and progressive cycle exercise. Forty-four adolescents with idiopathic scoliosis were studied. The mean forced vital capacity (FVC), expressed as a percentage of the predicted value, was 94.3 +/- 2.2 (SE). The mean ventilatory response to hypercapnia (2.57 +/- 0.24 L/min/mm Hg) was within the normal range but was achieved with a tidal volume response (1.87 +/- .17% vital capacity [VC]/mm Hg) that was significantly lower than that previously reported in healthy young adults. Ventilatory responses to exercise were also within the normal range, the mean dyspnea index (VE-max/maximal voluntary ventilation) = 0.92 +/- 0.04. However, at a ventilation of 30 L/min, the tidal volume was 0.38 +/- 0.01% FVC, which was considerably lower than predicted. The tidal volume response to hypoxia was also abnormally low, the mean response being 0.52 +/- 0.059% VC/% decrease in arterial O2 saturation. These findings indicated that, even when scoliosis is asymptomatic and associated with minimal impairment of resting pulmonary function, abnormal patterns of ventilation occur during exercise or in response to chemical stimuli.
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PMID:Ventilatory patterns during hypoxia, hypercapnia, and exercise in adolescents with mild scoliosis. 370 36

We present information about 118 pregnancies in 64 patients with thoracic scoliosis, two-thirds of whom had curves in excess of 60 degrees. Although increased breathlessness was experienced in 17% of pregnancies, no serious cardiorespiratory problems were encountered. Increased black pain occurred in 21% of pregnancies. Spontaneous vaginal delivery was achieved in 65% of pregnancies and caesarean section was performed in 17%. Operative delivery was almost invariably for purely obstetric indications. We conclude that even in severe thoracic scoliosis, pregnancy and labour are not associated with serious cardiorespiratory complications.
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PMID:Pregnancy in thoracic scoliosis. 730 64


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