Treatment results of triplanar correction of idiopathic scoliosis in relation to curve pattern and degree of scoliosis

Background. The King classification enables the surgeon to assess the curve pattern of scoliosis which determines the choice of operative technique as well as the extent of spinal fusion. The final outcome of operative treatment depends on the curve pattern and the degree of scoliosis. Material and methods. The aim of the study was to assess the relation between the correction of the deformity and the curve pattern. In this retrospective study, 97 patients were included who had undergone scoliosis surgery between 1999 and 2001, and for whom the follow-up period was at least 36 months. 12 patients were classified as type I according to the King classification, 26 as type II, 49 as type III, and 5 each as type IV and V. The mean Cobb angle in the whole group was 58 degrees in the thoracic region and 38 degrees in the lumbar region, while in the sagittal plane there was kyphosis of the thoraco-lumbar region of 3 degrees . Results. Postoperative values were as follows: thoracic region - 30.2 degrees , lumbar region - 27.6 degrees and thoraco-lumbar region - lordosis of 4 degrees . Conclusions. The Cotrel-Dubousset method makes it possible to achieve an average correction of 65% of the original deformity, the best result being achieved for type IV and V. Operative treatment should be applied to patients with scoliosis of an angle below 60 degrees , which enables compensation of trunk transposition.     

Effectiveness of a lifestyle modification programme in weight maintenance in obese subjects after cessation of treatment with Orlistat

OBJECTIVE: To examine the efficacy of a lifestyle modification programme in weight maintenance for obese subjects after cessation of treatment with Orlistat. METHODS: Fifty-five subjects with and without diabetes mellitus were randomized to a lifestyle modification programme or to usual care at the end of 6 months' treatment with Orlistat. The intervention programme was nutritionist led, consisting of components of dietary management, physical activity, peer group support and discussion using techniques of self-monitoring, stimulus control and cognitive restructuring. Anthropometric indices, body composition, basal metabolic rate, blood pressure, fasting glucose, glycosylated haemoglobin, lipid profile, 24-hour urinary albumin excretion, dietary intake, physical activity level, and quality of life were assessed before and after the intervention period. Results Subjects in the intervention group maintained their weight loss and favourable anthropometric, metabolic, dietary intake, physical activity and quality of life profiles, while most parameters deteriorated in the usual care group, being more marked in subjects with diabetes. The magnitude of weight gain was comparable to that lost during Orlistat treatment. CONCLUSION: A specially designed nutritionist-led lifestyle modification programme for obese subjects is effective in weight maintenance after treatment with Orlistat, in the absence of which the benefits of drug treatment were lost. The magnitude of the effect of lifestyle modification is comparable to that observed with Orlistat.     

Typhoid fever complicated by multiple organ involvement: report of two cases

Typhoid fever complicated by multiple organ involvement has been rarely mentioned in the literature. We reported two cases of typhoid fever with several unusual manifestations, including acute renal failure, acute hepatitis, acute pancreatitis, disseminated intravascular coagulation, and lower gastrointestinal bleeding. A renal biopsy in the first case showed no pathological change. Bone marrow biopsy showed focal necrosis of matrix, which might have been due to severe illness. A liver biopsy in the second case showed a predominantly histiocytic proliferation with occasional neutrophilic infiltration in the portal areas and hepatic sinusoids. Focal necrosis, bile duct injury, and multiple eosinophilic bodies were also noted. After appropriate antimicrobial therapy, both patients recovered without any sequelae. The potential of multiple organ involvement is highlighted in typhoid fever, which, on rare occasions, may occur simultaneously in the same patient.     

New parameters to represent the position of the aorta relative to the spine for pedicle screw placement

Parameters of the position of the aorta in previous reports were determined for anterior surgery. This study evaluated the relative position of the aorta to the spine by new parameters, which could enhance the safety of pedicle screw placement. Three parameters were defined in a new Cartesian coordinate system. We selected an entry point of a left pedicle screw as the origin. The transverse plane was determined to include both the bases of the superior facet and to be parallel to the upper endplate of the vertebral body. A line connecting the entry points of both sides was defined as the X-axis. The angle formed by the Y-axis and a line connecting the origin and the center of the aorta was defined as the left pedicle–aorta angle. The length of a line connecting the origin and the aorta edge was defined as the left pedicle–aorta distance. Distance from the edge of the aorta to the X-axis was defined as the pedicular line–aorta distance. These parameters were measured preoperatively in 293 vertebral bodies of 24 patients with a right thoracic curve. We simulated the placement of the pedicle screw with variable length and with some direction error. We defined a warning pedicle as that when the aorta enters the expected area of the screw. Sensitivity analysis was performed to find the warning pedicle ratio in 12 scenarios. The left pedicle–aorta angle averaged 29.7° at the thoracic spine and −16.3° at the lumbar spine; the left pedicle–aorta distance averaged 23.7 and 55.2 mm; the pedicular line–aorta distance averaged 18.3 and 51.0 mm, respectively. The ratio of warning pedicles was consistently high at T4–5 and T10–12. When a left pedicle screw perforates an anterior/lateral wall of the vertebral body, the aorta may be at risk. These new parameters enable surgeons to intuitively understand the position of the aorta in surgical planning or in placement of a pedicle screw.     

The use of AlloDerm on major burn patients: AlloDerm prevents post-burn joint contracture

In efforts to prevent and reduce joint contracture and scar formation after burn, we used the acellular human dermis (AlloDerm^®) as a dermal replacement in the acute stage. A total of 64 patients received AlloDerm^® graft selectively on joint areas during the study period from March, 2005 to July, 2007. From January to March, 2008, a total of 31 patients returned to our burn center to examine the functional results by measuring range of motion of joints. Additionally, the quality of grafted skin condition criteria of skin elasticity, scar thickness, trans-epidermal water loss, melanin and erythema level was measured in a total of 11 patients among them. By analyzing the limitation level of 55 joints excluding hand areas, we found that 24 joints (43.6%) showed no limitations, 12 joints (21.8%) showed limitations below 10%, 16 joints (29.1%) showed limitations between 10 and 19% and 3 joints (5.5%) showed limitations over 20%. The scar thickness of non-AlloDerm applied areas was 2.5 ± 0.9 mm and AlloDerm applied areas was 1.8 ± 0.7 mm (p = 0.396). Trans-epidermal water loss for non-AlloDerm applied areas was 20.9 ± 7.7 g/h/m² and AlloDerm applied areas was 10.8 ± 3.4 g/h/m² (p < 0.001). Erythema value for non-AlloDerm applied areas was 436.1 ± 65.8, whereas AlloDerm applied area was 394.4 ± 61.2 (p < 0.001). Acellular dermal matrix is a good option for treating major burns to prevent scar formation after burn and loss of joint function.