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

A 2 1/4 year-old boy was treated for cystinuria and urolithiasis with high fluid intake, sodium bicarbonate, and D-penicillamine, over a period of 5 3/4 years, unauthorized interruptions and prescribed pauses included. Therapy was partially sucessful but regrowth of calculi coincided with interruptions of D-penicillamine administration and also with the institution of a low-dose D-penicillamine regime. Flat feet, scoliosis, pectus carinatum, hypermobility of joints, molluscoid pseudotumors and atrophic scars were alarming side effects of D-penicillamine. However, the possibility was not excluded that a forme fruste of an Ehlers-Danlos syndrome preexisted in this boy and was effected by D-penicillamine. Only the molluscoid pseudotumors regressed when D-penicillamine was reduced or omitted temporarily. Osteolathyrism caused by D-penicillamine has hitherto not been reported in man.
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PMID:Skin and bone lesions (dermato-osteolathyrism), possible side effects of D-penicillamine treatment, in a boy with cystinuria. 15 71

The immediate effect of Boston brace removal on plasma levels of atrial natriuretic peptide and arginine vasopressin was studied in 10 patients with idiopathic scoliosis ranging in age from 12 to 16 years. Blood samples were drawn via the antecubital vein in the supine position with the brace on and 10 min after brace removal. ANP and AVP plasma levels were measured by radioimmunoassay. Although no differences were found in the plasma concentrations of arginine vasopressin while on and after removal of the brace, atrial natriuretic peptide levels showed an approximately 80 percent increase 10 min after brace removal, presumably due to central volume redistribution. The changes of atrial natriuretic peptide plasma levels observed may be related to previously reported changes of the glomerular filtration rate and urinary sodium excretion following brace removal.
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PMID:Effect on atrial natriuretic peptide by bracing in scoliosis. Boston brace removal studied in 10 cases. 183 55

The authors investigated the influence of controlled hypotension on renal function in patients operated on account of idiopathic scoliosis of the spine. The deformity was corrected by posterior fusion with Harrington instrumentation under general anaesthesia during controlled hypotension induced by sodium nitroprusside (n = 20). The control group was formed by 20 patients with the same deformity and the same surgical procedure without hypotension. The renal function was assessed before operation, during operation and continuously for 102 hours after operation. In the group of patients with controlled hypotension (median arterial pressure 8.0 kPa) during operation a significant decline of the creatinine clearance occurred (0.7 ml/s), as compared with the control group (1.3 ml/s), as well as compared with the value before operation (1.7 ml/s). After terminated hypotension the mean value of creatinine clearance rose to 2.0-2.2 ml/s for a period of 42 hours. In the control group the creatinine clearance persisted at a slightly reduced level, recorded during operation, for another 30 hours. Sodium retention as a manifestation of hyperaldosteronism was less marked in patients with controlled hypotension. During the investigation period no biochemical signs of retention of nitrogenous substances were recorded.
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PMID:[The effect of controlled hypotension on kidney function in spinal surgery]. 222 88

The effect of controlled hypotension on renal function in patients operated on for idiopathic scoliosis of the spine was examined (n = 20). The deformity was corrected under general anesthesia by posterior fusion using Harrington's instrumentation during controlled hypotension induced by sodium nitroprusside. The control group included 20 patients suffering the same deformity and operated on in the same way but without hypotension. Renal function tests were performed before and during the operation and continuously for 102 h after surgery. In the group with controlled hypotension (medium arterial pressure 8.0 kPa) there was a significant decrease in creatinine clearance during the operation (0.70 ml/s) compared with that in the control group (1.30 ml/s) and with the value before surgery (1.70 ml/s). At the end of hypotension, the average clearance value of creatinine increased up to 2.0-2.2 ml/s within 42 h. In the group of control patients (medium arterial pressure 11.5 kPa) the creatinine clearance persisted at a mildly decreased level (1.3 ml/s) during surgery and for a further 30 h after. The sodium retention characteristic of hyperaldosteronism was less marked in the patients with controlled hypotension. We did not observe any biochemical findings indicating retention of nitro substances. Controlled hypotension induced by sodium nitroprusside at surgical treatment of the vertebral column does not cause any impairment of the renal function either during surgery or as a late sequela.
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PMID:[The effect of controlled hypotension during spinal surgery on kidney function]. 233 75

In their work the authors observed the influence of controlled hypotension by means of sodium nitroprusside on the acidobasic balance, the oxygenation parameters, pulmonary shunt and lactatemia in patients with idiopathic scoliosis in the course of dorsal fusion by Harrington instrumentation. In comparison with the control group of patients there had not occurred significant - from the viewpoint of statistics - changes in ph, paCO2 and pvO2. However, the pulmonary shunt (Qva/Qt) doubled (p less than 0.002) which resulted in a significant decrease of paO2 (p less than 0.02) but in no case there occurred hypoxemia. The values of the lactate both in the venous and arterial blood were increased (p less than 0.001, or p less than 0.02) in contrast to the control group of patients, but they did not mean the increased production of lactate during intracellular hypoxia. As a result the regulated hypotension by means of sodium nitroprusside can be applied also in patients with altered pulmonary functions.
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PMID:[Changes in pulmonary shunting and blood lactate during general anesthesia with controlled hypotension in patients with idiopathic scoliosis]. 280 Aug 69

Eight paediatric patients undergoing major surgery for correction of scoliosis who were treated postoperatively with hypotonic saline and 5% dextrose have been studied. Plasma sodium, renin and aldosterone, and urine volume, sodium and osmolality were measured. These patients had an impaired ability to excrete a sodium-free water load. In the first 60 h urine volume remained reduced, while in the first 36 h urine sodium remained concurrently high. If the first 36 h postoperation are considered, the sodium-free water given was quantitatively retained and the serum sodium at 36 h was significantly correlated with the amount of free water given (P less than 0.01). To minimize postoperative hyponatraemia and the associated shift of water into the brain causing cerebral oedema, it is recommended that no more than 50 ml/kg sodium-free water be given until urine sodium falls and volume increases.
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PMID:Pathogenesis of postoperative hyponatraemia following correction of scoliosis in children. 307 98

Controlled hypotension which is used during scoliosis surgery to improve operating conditions and minimize transfusion requirements may decrease spinal cord blood flow (SCBF). Previous studies using hydrogen washout, an invasive technique, have shown that trimethaphan-induced hypotension is associated with a decrease in SCBF, whereas hypotension induced with sodium nitroprusside or nitroglycerin is not. To determine whether the decrease seen with trimethaphan represented a generalized rather than regional spinal cord phenomenon, SCBF was measured at three separate cord levels (T2-3, 7-8, L2-3) using a noninvasive radionuclide-labelled microsphere technique. When the mean arterial pressure was reduced by 50%, SCBF decreased 35 to 45% at all levels of the cord examined, and remained at this reduced level during the period of hypotension. The results confirm that trimethaphan-induced hypotension is associated with a significant reduction in SCBF and that this occurs throughout the spinal cord during the period of hypotension.
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PMID:The effect of trimethaphan-induced hypotension on canine spinal cord blood flow. Measurement at different cord levels using radiolabelled microspheres. 318 93

By combining surgical and anesthetic techniques that minimize blood loss with the use of autotransfusion, it should now be possible to complete a routine posterior spinal fusion without using allogeneic blood transfusions. Surgical efforts should include careful preoperative planning, positioning with the abdomen hanging free, use of topical hemostatic agents, and decortication late in the procedure. Preoperatively donated autogeneic blood or reclaimed red cells from suction can take the place of allogeneic transfusions. Blood loss during scoliosis surgery correlates closely with left ventricular stroke work index (LVSWI), a measure of blood flow calculated from systemic vascular resistance, cardiac output, and heart rate. All of these parameters are under the anesthesiologist's control, making him the primary determinant of blood loss in scoliosis surgery. Induced hypotensive anesthesia may be ineffective in controlling blood loss if the cardiac output or heart rate is high. Halothane, a commonly used hypotensive agent, is not very useful for scoliosis surgery because spinal cord monitoring and wake-up testing are not possible. Rebound hypertension has been noted with the use of sodium nitroprusside. Trimethaphan works well clinically but experimentally it reduces spinal cord blood flow, which may increase the risk of spinal cord injury.
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PMID:Control of blood loss during scoliosis surgery. 328 Feb 5

Ten adolescent and preadolescent patients who underwent posterior spinal fusion for idiopathic scoliosis or spondylolisthesis were examined for the presence or absence of the postoperative syndrome of inappropriate antidiuretic-hormone secretion. For each patient, levels of serum sodium, serum osmolality, urine sodium, urine osmolality, and serum antidiuretic hormone were obtained preoperatively and postoperatively. The investigation clearly showed that the syndrome occurred in each patient, with the level of serum antidiuretic hormone being highest within a few hours postoperatively. This resulted in a reduction of urinary output, the reduction being maximum on the day of operation and the output gradually rising to normal over the next three days. This syndrome and its associated low postoperative urinary output is common after spinal fusion and should be treated with restriction of fluids rather than administration of increased amounts of fluid.
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PMID:The syndrome of inappropriate antidiuretic-hormone secretion following spinal fusion. 372 28

Deliberate hypotension is used in scoliosis surgery to reduce the need for blood transfusion and to improve operating conditions. There are concerns, however, that hypotension may decrease spinal cord blood flow (SCBF) and thereby predispose the spinal cord to ischemic injury, particularly when it is distracted during Harrington instrumentation. In a canine model, the mean arterial pressure (MAP) was reduced to 50% of the normotensive value with sodium nitroprusside and halothane to study its effects, with and without spinal distraction, on spinal cord blood flow measured by the hydrogen clearance technique. The induction of systemic hypotension resulted in a significant decrease in spinal cord blood flow from 15.7 +/- 1.1 ml/min/100 g (control) to 10.7 +/- 4.7 ml/min/100 g. This initial decrease in spinal cord blood flow returned to normotensive values by 35 minutes following the induction of hypotension, suggesting an autoregulatory effect. This indicates that the induction of deliberate hypotension to half its normotensive mean arterial pressure is associated with a significant decrease in spinal cord blood flow that returns to normotensive levels by 35 minutes. One and two centimeters of longitudinal distraction applied during systemic hypotension did not reduce spinal cord blood flow when it was applied at least 45 minutes after the hypotension was induced. Thus, when longitudinal stretch of a magnitude approximating that used clinically during Harrington instrumentation is applied in the presence of systemic hypotension, the normal SCBF is not reduced when the autoregulating system is functioning.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The influence of induced hypotension and spine distraction on canine spinal cord blood flow. 383 54


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