Height of girls with adolescent idiopathic scoliosis

In a Finnish population, the standing height of 1500 consecutive female patients aged 9-24 years (mean 13.9 years) with untreated idiopathic scoliosis of at least 10 degrees in their lateral curves was compared with the standing height of average girls. The mean magnitude of the major curves was 29.4 degrees (range 10 degrees-80 degrees), and that of the minor curves 20.3 degrees (range 0 degrees-66 degrees). A formula for the height loss caused by the lateral curves, and that caused by thoracic kyphosis, was derived. The corrected height of the girls with idiopathic scoliosis was highly significantly (P<0.001) greater than the height of average girls at the age of 11-15, and this high level of significance was present at the age of 11-13, even without correcting for the height loss caused by scoliosis. After maturation, the girls with idiopathic scoliosis were not significantly taller than average girls. On average, the magnitude of thoracic kyphosis did not affect the height of patients with scoliosis as compared with the height of normal girls of the same age.     

匹多莫德治疗儿童过敏性紫癜疗效评价

目的：评价匹多莫德对儿童过敏性紫癜的治疗效果。方法选取90例过敏性紫癜患儿,随机分为实验组(n=45)和对照组(n=45),实验组使用匹多莫德联合常规方法治疗过敏性紫癜,对照组予常规方法治疗,比较两组患儿临床症状消失时间,以及IgG、IgA、IgM和T淋巴细胞亚群变化情况。结果(1)实验组临床症状消失时间及住院时间较对照组明显缩短,差异有统计学意义(P<0.01);实验组皮肤紫癜反复发生率显著低于对照组,差异有统计学意义(P<0.05)。(2)治疗前两组外周血IgG、IgA、IgM水平以及T淋巴细胞亚群差异无统计意义(孕>0.05);治疗结束后,实验组IgA和CD8+水平较对照组显著降低,其IgG、IgM、CD4+和CD4+/CD8+水平较对照组显著升高,差异有统计学意义(P<0.05)。(3)实验组病情复发率较对照组明显降低,差异有统计学意义(P<0.05)。结论匹多莫德联合常规方法治疗HSP效果好,临床治疗中值得借鉴参考。     

三七粉致荨麻疹合并过敏性紫癜1例

三七粉致荨麻疹合并过敏性紫癜1例。     

Masked severe stenosing ureteritis: a rare complication of Henoch-Schönlein purpura

Henoch-Schönlein purpura (HSP)-associated stenosing ureteritis represents a rare complication of the disease, typically presenting with severe manifestations. This article reports on a 3.5-year-old boy with HSP and severe nephritis who developed a unilateral stenosing ureteritis with atypical manifestations, resulting in a nonfunctional kidney and consequent nephrectomy. The urinary tract ultrasound was normal in the first week of illness, and the diagnosis was made during follow-up 8 months after onset. The predominance of nephritic manifestations may have masked any signs of ureteritis, leading to the delay in diagnosis. To clarify the clinical spectrum of this complication, an extensive review of the literature was performed. We emphasize the necessity of repeated urinary tract ultrasound both early and later in the course of HSP, especially in cases with renal involvement, so that an early diagnosis of this complication can prevent a potentially serious renal outcome.     

Radiographic versus ultrasound evaluation of the Risser Grade in adolescent idiopathic scoliosis: a prospective study of 46 patients

The determination of skeletal age is essential in the management of patients with scoliosis. One of the most frequently used techniques to determine skeletal maturity is the method described by Risser. However, repeated X-ray exposure in the follow-up examinations of scoliosis patients may increase the risk of cancer. We compared conventional radiological evaluation of the Risser grade with ultrasound evaluation. For scoliosis patients routine application of ultrasound in the follow-up examinations may significantly reduce radiation exposure. 46 adolescent idiopathic scoliosis patients (median age, 14.5 years) were investigated. Sonographic and radiographic assessment of Risser sign was carried out by two independent senior staff skeletal radiologists. Agreement of Risser Grade between the two diagnostic methods was determined by Kappa statistics. Coefficients <0.21, 0.21–0.40, 0.41–0.60, 0.61–0.80, and >0.80 were rated as poor, fair, moderate, good, and very good agreement. For Risser Grades I–III 100% agreement was found between the two methods. Disagreement between radiographic and sonographic evaluation was found in Risser Grades IV and V. In five patients, X-ray evaluation yielded Risser Grade V while ultrasound showed Risser Grade IV. In one patient, radiographic examination resulted in Risser Grade IV while Grade V was detected in ultrasound. Overall, the Kappa value showed very good agreement between the two diagnostic methods. Our findings suggest that ultrasound can be applied as an alternative method to X-ray evaluation in Risser Grade determination. It should be routinely used in clinical practice to reduce the patients exposure to radiation.     

Cheneau支具治疗青少年特发性脊柱侧凸

目的探讨Cheneau支具治疗青少年特发性脊柱侧凸的临床效果.方法我们分析了1998年5月～2000年12月共38例特发性脊柱侧凸患者,均给予了Cheneau支具治疗.结果经平均15个月随访(5～30个月),除1例因中止治疗使角度加大而改行手术外,其余患者均得到不同程度的改善,平均矫正12°(-6～24°),无明显并发症.结论我们认为对于Risser征为0,侧凸角度>20°的特发性侧凸患者应尽早行支具治疗.     

骨移植在青少年特发性脊柱侧凸后路矫形术的应用研究

[目的]通过不同植骨在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用比较,探讨其临床应用效果.[方法]回顾性分析2000年～2005年行后路钉-棒系统矫形手术的71例青少年特发性脊柱侧凸患者,其中自体骨移植21例(A组),同种异体骨移植23例(B组),自体骨混合同种异体骨移植27例(C组),比较随访第3、9、15、36个月的融合率、Cobb's角丢失率及假关节发生率.[结果]A组平均融合节段7个,B组平均融合节段7.6个,C组平均融合节段8个.随访的第3个月,融合率、Cobb's角丢失率及假关节发牛率A组、B组、C组无显著性差异(P＞0.05).第9个月,A组融合率高于B、C两组,A组与B、C组有显著性差异(P＜0.05),B、C组间无显著性差异(P＞0.05),Cobb's角丢失率及假关节发生率A、B、C组无显著性差异(P＞0.05).第15、36个月,融合率、Cobb's角丢失率及假关节发牛率A、B、C组无显著性差异(P＞0.05).[结论]同种异体骨移植、自体骨混合同种异体骨移植与自体骨移植在青少年特发性脊柱侧凸后路矫形手术中对维持矫形效果可取得相近的近远期临床效果.     

The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis

The risk of impingement of the aorta associated with thoracic vertebral screw or pedicle screw instrumentation in the treatment of thoracic scoliosis has been an important concern. To understand this phenomenon more systematically, the relative position of the aorta with reference to the thoracic vertebrae in right thoracic adolescent idiopathic scoliosis (AIS) following anterior and posterior spinal instrumentation was analyzed in detail quantitatively; 34 patients underwent anterior (n = 14) or posterior (n = 20) spinal instrumentation were recruited in the present study. The relative position of the thoracic aorta, vertebral rotation, apical vertebral translation and thoracic kyphosis were measured from pre- and post-operative CT images from T5 to T12. The aorta was found to shift antero-medially in the anterior instrumentation group but not in the posterior spinal instrumentation group. It is likely that the disc removal, soft tissue release and spontaneous vertebral derotation of the scoliosis could account for the antero-medial shifting of the aorta. By the shifting, the space for contralateral screw penetration was reduced.     

An adult patient with Kabuki syndrome presenting with Henoch-Schönlein purpura complicated with pulmonary hemorrhage

We present a case of a 33-year-old woman with Kabuki syndrome (KS) presenting with Henoch-Schönlein purpura (HSP). She was admitted to our hospital with a brain abscess in the lateral ventricle and meningitis. She had been diagnosed with KS. Skin eruptions had appeared on her lower extremities, with arthralgia, cough, and hemoptysis. She suddenly developed pulmonary hemorrhage and respiratory failure. We intubated her trachea and started mechanical ventilation in the intensive care unit (ICU). Skin biopsy revealed leukocytoclastic vasculitis with granular depositions of immunoglobulin A (IgA) in dermal vessel walls, and she was diagnosed as having HSP. Supportive management and prednisolone at 20 mg·day^?1 cured the pulmonary hemorrhage and respiratory failure. On ICU day 27, she was weaned from mechanical ventilation. Pulmonary hemorrhage as a complication of HSP is rare and sometimes fatal. KS is often associated with an increased incidence of infection and congenital heart disease. Susceptibility to infection and pulmonary hypertension due to congenital heart disease in this patient may have led to the development of the pulmonary hemorrhage. Supportive care and steroid therapy appeared to be beneficial in the treatment of this patient with HSP with pulmonary hemorrhage.     

Management of a parturient with an acute exacerbation of idiopathic pulmonary haemosiderosis and posterior spinal instrumentation

Idiopathic pulmonary haemosiderosis (IPH) is a rare conditionassociated with diffuse alveolar haemorrhage and pulmonary fibrosis.We describe the anaesthetic management of a parturient witha history of posterior spinal fusion presenting with an acuteexacerbation of IPH necessitating vaginal delivery at 34 weeksgestation. We used a spinal catheter for labour analgesia andbilevel positive airway pressure (BIPAP) ventilation to improveoxygenation during labour. An arterial line sited to allow frequentarterial blood gas sampling also facilitated continuous cardiacoutput monitoring. The use of a carefully titrated neuraxialblock for analgesia, in conjunction with BIPAP, was associatedwith minimal haemodynamic and respiratory compromise duringlabour in this patient.