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The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions. Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP. During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46–34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p

Background and objective: The availability of chest computed tomography (CT) imaging can help diagnose comorbidities associated with chronic obstructive pulmonary disease (COPD). Their systematic identification and relationship with allcause mortality have not been explored. Furthermore, whether their CT-detected prevalence differs from clinical diagnosis is unknown. Methods: The prevalence of 10 CT-assessed comorbidities was retrospectively determined at baseline in 379 patients (71% men) with mild to severe COPD attending pulmonary clinics. Anthropometrics, smoking history, dyspnoea, lung function, exercise capacity, BODE (BMI, Obstruction, Dyspnoea and Exercise capacity) index and exacerbations rate were recorded. The prevalence of CT-determined comorbidities was compared with that recorded clinically. Over a median of 78 months of observation, the independent association with all-cause mortality was analysed. A ‘CT-comorbidome’ graphically expressed the strength of their association with mortality risk. Results: Coronary artery calcification, emphysema and bronchiectasis were the most prevalent comorbidities (79.8%, 62.7% and 33.9%, respectively). All were underdiagnosed before CT. Coronary artery calcium (hazard ratio [HR] 2.09; 95% CI 1.03–4.26, p = 0.042), bronchiectasis (HR 2.12; 95% CI 1.05–4.26, p = 0.036) and low psoas muscle density (HR 2.61; 95% CI 1.23–5.57, p = 0.010) were independently associated with all-cause mortality and helped define the ‘CT-comorbidome’. Conclusion: This study of COPD patients shows that systematic detection of 10 CT-diagnosed comorbidities, most of which were not detected clinically, provides information of potential use to patients and clinicians caring for them.

Antecedentes: El ensanchamiento anormal de la arteria pulmonar (EAP) detectado mediante tomografía axial computarizada de tórax (TAC) está asociado con peores resultados de salud en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Objetivos. Evaluar si la hipoxemia nocturna que puede producirse en fumadores con o sin EPOC, con o sin apnea obstructiva del sueño (AOS) o con EPOC y AOS, puede estar asociada con EAP. Métodos. Se analizaron los datos transversales de dos cohortes prospectivas que incluyeron a 284 fumadores reclutados en contexto de un programa de cribado de cáncer de pulmón o consulta de neumología general y que en la visita inicial completaron TAC y poligrafía de sueño ambulatoria. En la TAC se midió el diámetro del tronco de la arteria pulmonar (dAP) y la relación del dAP con el diámetro de la raíz de la arteria aorta (dAP/dAo). Se definió la presencia de EAP en casos de dAP ≥ 29 mm en hombres y ≥ 27 mm en mujeres. Para ambos sexos, también se definió EAP si el dAP/dAo era > 0.9. La asociación de EAP con las características basales se estimó mediante modelos de regresión logística multivariable. Resultados. La prevalencia de EAP determinada por la medición del dAP o por la relación dAP/dAo fue de 27% y 11.6% respectivamente. El dAP se relacionó de forma independiente con la obesidad, definida como un índice de masa corporal ≥ 30 kg/m2 (OR 2.01; 95%CI 1.06–3.78), un menor volumen espiratorio forzado en el primer segundo (FEV1) (OR 1.03; 95%CI 1.02–1.05) y un mayor nivel de hipoxemia nocturna calculada como % de tiempo del registro de sueño con una SaO2 < 90% (T90) (OR 1.02; 95%CI 1.00–1.03). Solo el T90 fue una variable independiente asociada a EAP, cuando ésta se definió por la relación dAP/dAo (OR 1,02; 95%CI 1,01–1,03). Excluyendo a los sujetos con AOS, los análisis demuestran que solo T90 se mantiene como una variable determinante de EAP tanto definida por el dAP (OR 1.02; 95%CI 1.01–1.03) como definida por la relación dAP/dAo (OR 1.04; 95%CI 1.01–1.07). Conclusiones: En fumadores con o sin EPOC, la hipoxemia nocturna se asocia con EAP independientemente de la coexistencia de AOS. Background: Pulmonary artery enlargement (PAE) detected using chest computed tomography (CT) is associated with poor outcomes in chronic obstructive pulmonary disease (COPD). Aim. To assess whether nocturnal hypoxemia occurring in smokers, with or without COPD, obstructive sleep apnea (OSA) or their overlap, may be associated with PAE assessed by chest CT. Methods. We analyzed data from two prospective cohort studies that enrolled 284 smokers from a lung cancer screening program or general pulmonology consult including baseline home sleep apnea studies and chest CT scans. Main pulmonary artery diameter (PAD) and the ratio of the PAD to that of the aorta (PA:Ao ratio) were measured. PAE was defined as a PAD ≥ 29 mm in men and ≥ 27 mm in women or as a PA:Ao ratio > 0.9. We evaluated the association of PAE with baseline characteristics using multivariable logistic models. Results: PAE prevalence was 27% as defined by PAD measurements and 11.6% by the PA:Ao ratio. A body mass index ≥ 30 kg/m2 (OR 2.01; 95%CI 1.06–3.78), lower % predicted of forced expiratory volume in one second (FEV1) (OR 1.03; 95%CI 1.02– 1.05) and higher % of sleep time with O2 saturation < 90% (T90) (OR 1.02; 95%CI 1.00–1.03), were associated with PAE as determined by PAD. However, only T90 remained significantly associated with PAE as defined by the PA:Ao ratio (OR 1.02; 95%CI 1.01–1.03). In the subset group without OSA, only T90 remains associated with PAE, whether defined by PAD measurement (OR 1.02; 95%CI 1.01–1.03) or PA:Ao ratio (OR 1.04; 95%CI 1.01–1.07). Conclusions: In smokers with or without COPD, nocturnal hypoxemia was associated with PAE independently of OSA coexistence.

[Background] The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression., [Research Question] What is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression?, [Study Design and Methods] We phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time., [Results] The mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV1 % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039)., [Interpretation] Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function., [Trial Registry] ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov, This study was funded in part by an unrestricted grant from AstraZeneca, and also by the COPD Research Program of the Spanish Respiratory Society (PII de EPOC of SEPAR).

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV2) disease (COVID-19) is a novel threat that hampers life expectancy especially in obese individuals. Though this association is clinically relevant, the underlying mechanisms are not fully elucidated. SARS CoV2 enters host cells via the Angiotensin Converting Enzyme 2 receptor, that is also expressed in adipose tissue. Moreover, adipose tissue is also a source of many proinflammatory mediators and adipokines that might enhance the characteristic COVID-19 cytokine storm due to a chronic low-grade inflammatory preconditioning. Further obesity-dependent thoracic mechanical constraints may also incise negatively into the prognosis of obese subjects with COVID-19. This review summarizes the current body of knowledge on the obesity-dependent circumstances triggering an increased risk for COVID-19 severity, and their clinical relevance

The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions.Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP.During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46-34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p 0.0001), and the VR decreased to 26.9% (p 0.609). All patients' symptoms and complications were mild (according Clavien-Dindo grades I and II), and there were no loop injuries, no catheter complications, or any surgical re-interventions.The study suggests that the use of this method results in a significant increase in ACV, and reduction of the herniated content in a safe and efficient manner, with mild complications.

Obstructive sleep apnea (OSA) is a worldwide highly prevalent disease associated with systemic consequences, including excessive sleepiness, impairment of neurocognitive function and daytime performance, including driving ability. The long-term sequelae of OSA include and increase risk for cardiovascular, cerebrovascular and metabolic syndrome disorders that ultimately lead to premature death if untreated. To ensure optimal long-term outcomes, the assessment and management of OSA should be personalized with the involvement of the appropriate specialist. Most studies have demonstrated inmediate improvement in daytime somnolence and quality of life with CPAP and other therapies, but the effect of long-term treatment on mortality is still under debate. Currently, the long-term management of OSA should be based on a) identifying physiological or structural abnormalities that are treatable at the time of patient evaluation and b) comprehensive lifestyle interventions, especially weight-loss interventions, which are associated with improvements in OSA severity, cardiometabolic comorbidities, and quality of life. In long-term management, attention should be paid to the clinical changes related to a potential reoccurrence of OSA symptoms and it is also necessary to monitor throughout the follow up how the main associated comorbidities evolve.

Objectives: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. Patients and methods: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range, 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1 +/- 10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre-and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. Results: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2 degrees preoperatively and 20.4 degrees postoperatively. In preoperative period, MP and NSA were 72.7% and 160 degrees, respectively, which improved to 24.3% and 130 degrees, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p

OBJECTIVES: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. PATIENTS AND METHODS: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1±10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre- and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. RESULTS: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2° preoperatively and 20.4° postoperatively. In preoperative period, MP and NSA were 72.7% and 160°, respectively, which improved to 24.3% and 130°, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p

In this study, growth traits of Karakaş lambs, which are bred in rural farın conditions, from birth to weaning, body measurements at birth and weaning were described.Birth weig.l.ıt, lst, 2nd, 3rd and 4th month live weights, weight at weaning and daily average weight gain were 3.91, 8.80, 14.12, 20.43, 25.13, 25.09 and 0.176 kg, respectively. These traits were comparable to the traits described in other native breeds .Height at withers, hearth girth, hearth depth, legs girth, hearth width back of withers, body length at birth and weaning were 37.24±0.53 cm and 56.50±0.55 cm, 36.97±0.39 cm and 73.13±0 .86 cm, 13.51±0.44 cm and 25.02±0.22 cm, 28.57±0.67 cm and56.70±0 .80 cm, 8.36±0.16 cm and 16.42±0.19 cm, 25.65±0.43 cm and 56.22±0.55 cm, respectively ., Bu çalışmada köylü koşullarında yetiştirilen Karakaş kuzularında sütten kesim dönemine kadarki büyüme-gelişme özellikleri ile doğum ve sütten kesim dönemlerinde vücut ölçüleri tanımlanmıştır.Bu çalışmada ele alınan özelliklerden doğum ağırlığı, 1., 2., 3., ve 4. ay ağırlıkları ve sütten kesim ağırlığı ile günlük ortalama canlı ağırlık artışı sırasıyla 3.91±0.95, 8.80±0.19, 14.12±0.38, 20.43±0.44, 25.13±0.82, 25.09±0.52 ve 0.176±0.004 kg olarak saptanmıştır. Bu özellikler diğer yerli koyun ırklarımız üzerinde yapılan araştırmalarda saptanan . özelliklerle karşılaştırılabilir niteliktedir.Ele alınan vücut ölçüleri doğumda ve sütten kesim döneminde sırasıyla cidago yüksekliği (CY) 37.24±0 .53 cm ve 56.50±0. 5 cm, göğüs çevresi (GÇ) 36.97±0.39 cm ve 73.13±0.86 cm, göğüs derinliği (GD) 13.51±0.44 cm ve 25.02±0.22 cm, but çevresi (BÇ) 28.57±0 .67 cm ve 56.70±0 .80 cm, kürekler arkası göğüs genişliği (KAGG) 8.36±0.16 cm ve 16.42±0.19 cm, vücut uzunluğu (VU) 25.65±0.43 cm ve 56.22±0 .55 cm olarak saptanmıştır .

Objective: The aim of this study was to investigate the influence of the antiproliferative agent 5-Fluorouracil (5FU) over inhibition of spinal bone formation in an experimental rat model. Methods: The study included 30 6-month-old Sprague-Dawley rats divided into 3 groups. Aggressive periosteal denuding was performed by Scalpel, to induce punctuate bleeding in the posterior elements of the L4-L5 vertebrae in the spontaneous fusion model. Spinous processes were fixated by wires and no graft substitute was applied. Adcon-L was applied in Group 1, single-touch technique 5FU in Group 2. Group 3 was the control group. Rats were sacrificed at 4 weeks and specimens acquired for histological examination. Results: 5FU substantially inhibited:fibroblast and inflammatory cell densities as well as bone formation compared to the control group. 5FU was considerably superior to Adcon-L with regard to inhibition of bone formation and inflammatory cells (p=0.0001). Conclusion: 5FU can inhibit fusion, fibrosis and unwanted scar tissue in spinal surgery. We believe that after further studies on its local delivery dose, it can be used in humans for inhibition of unintended fusion.

BACKGROUND: Lower extremity angular deformities are common in children with skeletal dysplasia and can be treated with various surgical options. Both acute correction by osteotomy with internal fixation and gradual correction by external fixation have been used with acceptable results. Recently, the Guided Growth concept using temporary hemiepiphysiodesis for correction of angular deformities in the growing child has been proposed. This study presents the results of temporary hemiepiphysiodesis using eight- Plates and medial malleolus transphyseal screws in children with skeletal dysplasia with lower extremity angular deformities. METHODS: Twenty-nine patients (50 lower extremities) with skeletal dysplasia of different types were treated for varus or valgus deformities at 2 centers. The mean age at the time of hemiepiphysiodesis was 10±2.9 years. A total of 66 eight-Plates and 12 medial malleolus screws were used. The average follow-up time between the index surgery and the latest follow-up with the eight-Plate in was 25±13.4 months. Erect long-standing anteroposterior and lateral view radiographs were obtained for deformity planning before the procedure. Angular deformities on radiograph were evaluated by mechanical axis deviation, mechanical lateral distal femoral angle, medial proximal tibial angle, and lateral distal tibial angle. Mechanical axis deviation was also expressed as a percentage to one half of the width of the tibial plateau, and the magnitude of the deformity was classified by determining the zones through which the mechanical axis of the lower extremity passed. Four zones were determined on both the medial and lateral side of the knee and the zones were labeled 1, 2, 3, and 4, corresponding to the severity of the deformity. A positive value was assigned for valgus alignment and a negative for varus alignment. RESULTS: Patients were analyzed in valgus and varus groups. There was correction in 34 of 38 valgus legs and 7 of 12 varus legs. In the valgus group, the mean preoperative and postoperative mechanical lateral distal femoral angles were 82.1±3.7 and 91.1±4.9 degrees, respectively (P

OBJECTIVE: The aim of this study was to investigate the influence of the antiproliferative agent 5-Fluorouracil (5FU) over inhibition of spinal bone formation in an experimental rat model. METHODS: The study included 30 6-month-old Sprague-Dawley rats divided into 3 groups. Aggressive periosteal denuding was performed by scalpel to induce punctuate bleeding in the posterior elements of the L4-L5 vertebrae in the spontaneous fusion model. Spinous processes were fixated by wires and no graft substitute was applied. Adcon-L was applied in Group 1, single-touch technique 5FU in Group 2. Group 3 was the control group. Rats were sacrificed at 4 weeks and specimens acquired for histological examination. RESULTS: 5FU substantially inhibited fibroblast and inflammatory cell densities as well as bone formation compared to the control group. 5FU was considerably superior to Adcon-L with regard to inhibition of bone formation and inflammatory cells (p=0.0001). CONCLUSION: 5FU can inhibit fusion, fibrosis and unwanted scar tissue in spinal surgery. We believe that after further studies on its local delivery dose, it can be used in humans for inhibition of unintended fusion.

Objectives: The aim of this study is to evaluate the outcomes of eight-plate (Orthofix) use during hemiepiphyseodesis operation for growth modulation in obese children with adolescent Blount disease. Patients and methods: Six limbs of five consecutive patients who underwent lateral proximal tibial eight-plate (Orthofix) hemiepiphysiodesis were evaluated. The body mass index (BMI) was >30 and the severity of the deformity was in Zone III according to the Mielke and Stevens definition. The mechanical medial proximal tibial angle (MPTA) and the mechanical axis deviation (MAD) were measured preoperatively, postoperatively, and at last follow-up. The outcome of the procedure was established by the degree of tibia vara correction degree at final plate removal or skeletal maturity. Results: Mean age of the patients and mean BMI at the time of surgery was 13 years (range 12 to 14) and 33.5 kg/m(2) (range 31 to 36), respectively. Patients were followed for an average of 22 months (range 13 to 31). Preoperative and last follow-up mean values for MPTA were 81 and 80 degrees, respectively. Outcome of the procedure showed two extremities demonstrated progression of the tibia vara (mean of 6.5 degrees), two extremities had no correction of the deformity, and the remaining two extremities showed minimally improvement (mean 3 degrees). The procedure failed to correct the tibia vara in all extremities and all patients were scheduled for an osteotomy to treat the deformity. Conclusion: We do not recommend the use of a tension band plate hemiepiphyseodesis (eight-plate, Orthofix) to treat severe adolescent Blount disease in obese children.

OBJECTIVES: In this study, we aimed to characterize the outcomes of posterior spinal fusion (PSF) using titanium instrumentation in neuromuscular scoliosis (NMS) patients with a special focus on deformity correction and correction maintenance. PATIENTS AND METHODS: Between 2002 and 2004, nine patients (5 girls and 4 boys; mean age 14.9±2.3 years; range 11 to 19 years) with NMS who underwent PSF using titanium instrumentation were retrospectively analyzed. The mean height at surgery was 154.6±14.2 cm (range, 136-173 cm) and the mean weight was 59.4±19.2 kg (range, 26-114 kg). The mean follow-up duration was 3.7 years (range, 2-5 years). Preoperative data included demographics, curve type, and surgical indication. Rod size, fusion levels, duration of the operation (min), estimated blood loss (cc), and length of stay in hospital (day) were also evaluated intraoperatively. Postoperative data included correction of deformity, maintenance of correction, and complications. Radiographic measurements were obtained from standing posterior-anterior and lateral spinal radiographs at preoperative, postoperative (at first week after standing; i.e. first erect) and last follow-up visits. The data obtained were analyzed using descriptive statistic methods (mean, standard deviation, median, frequency and percentage). RESULTS: Dramatic improvements in the spinal deformities were observed in the patients with NMS who underwent PSF using titanium instrumentation. Mean preoperative Cobb angle was reduced from 69.7 degrees to 16.2 degrees at first erect following surgery (at first week; 77% correction). Two-year follow-up revealed that this correction sustained (mean 14.8 degrees). However, moderate to severe postoperative complications requiring careful monitoring were reported. CONCLUSION: Our study results showed that PSF with titanium instrumentation in pediatric NMS patients demonstrated satisfactory outcomes during the follow-up period. However, further large-scale studies with a long-term follow-up results are required to generalize the results regarding PSF using titanium instrumentation in these patients.

OBJECTIVES: The aim of this study is to evaluate the outcomes of eight-plate (Orthofix) use during hemiepiphyseodesis operation for growth modulation in obese children with adolescent Blount disease. PATIENTS AND METHODS: Six limbs of five consecutive patients who underwent lateral proximal tibial eight-plate (Orthofix) hemiepiphysiodesis were evaluated. The body mass index (BMI) was >30 and the severity of the deformity was in Zone III according to the Mielke and Stevens definition. The mechanical medial proximal tibial angle (MPTA) and the mechanical axis deviation (MAD) were measured preoperatively, postoperatively, and at last follow-up. The outcome of the procedure was established by the degree of tibia vara correction degree at final plate removal or skeletal maturity. RESULTS: Mean age of the patients and mean BMI at the time of surgery was 13 years (range 12 to 14) and 33.5 kg/m2 (range 31 to 36), respectively. Patients were followed for an average of 22 months (range 13 to 31). Preoperative and last follow-up mean values for MPTA were 81 and 80 degrees, respectively. Outcome of the procedure showed two extremities demonstrated progression of the tibia vara (mean of 6.5 degrees), two extremities had no correction of the deformity, and the remaining two extremities showed minimally improvement (mean 3 degrees). The procedure failed to correct the tibia vara in all extremities and all patients were scheduled for an osteotomy to treat the deformity. CONCLUSION: We do not recommend the use of a tension band plate hemiepiphyseodesis (eight-plate, Orthofix) to treat severe adolescent Blount disease in obese children.

Objectives: In this study, we aimed to characterize the outcomes of posterior spinal fusion (PSF) using titanium instrumentation in neuromuscular scoliosis (NMS) patients with a special focus on deformity correction and correction maintenance. Patients and methods: Between 2002 and 2004, nine patients (5 girls and 4 boys; mean age 14.9 +/- 2.3 years; range 11 to 19 years) with NMS who underwent PSF using titanium instrumentation were retrospectively analyzed. The mean height at surgery was 154.6 +/- 14.2 cm (range, 136-173 cm) and the mean weight was 59.4 +/- 19.2 kg (range, 26-114 kg). The mean follow-up duration was 3.7 years (range, 2-5 years). Preoperative data included demographics, curve type, and surgical indication. Rod size, fusion levels, duration of the operation (min), estimated blood loss (cc), and length of stay in hospital (day) were also evaluated intraoperatively. Postoperative data included correction of deformity, maintenance of correction, and complications. Radiographic measurements were obtained from standing posterior-anterior and lateral spinal radiographs at preoperative, postoperative (at first week after standing; i.e. first erect) and last follow-up visits. The data obtained were analyzed using descriptive statistic methods (mean, standard deviation, median, frequency and percentage). Results: Dramatic improvements in the spinal deformities were observed in the patients with NMS who underwent PSF using titanium instrumentation. Mean preoperative Cobb angle was reduced from 69.7 degrees to 16.2 degrees at first erect following surgery (at first week; 77% correction). Two-year follow-up revealed that this correction sustained (mean 14.8 degrees). However, moderate to severe postoperative complications requiring careful monitoring were reported. Conclusion: Our study results showed that PSF with titanium instrumentation in pediatric NMS patients demonstrated satisfactory outcomes during the follow-up period. However, further large-scale studies with a long-term follow-up results are required to generalize the results

STUDY DESIGN: A prospective study of ultrasonographic evaluation (UE) results of the Risser sign (RS) in adolescents. OBJECTIVE: This study aims to assess the efficiency of UE of RS, compare it with radiographic evaluation, and investigate the intraexaminer and interexaminer reliability of UE. SUMMARY OF BACKGROUND DATA: The use of ultrasound in orthopedic practice has a growing popularity. As a noninvasive radiological method, the evaluation of RS seems to be a promising alternative in patients suffering from scoliosis who require a long-term follow-up. METHODS: This study consists of 142 patients (70 female and 72 male cases) aged between 10 and 17 years, with a mean age of 13.8 ± 1.7 years. Menarche experience, body mass index, and skinfold thickness of the patients were recorded. Forty-five patients were found to have scoliosis. All ultrasonographic and radiographic evaluations were made by 2 blinded orthopedists. X-ray was considered as the gold standard. RESULTS: Percentage accuracy of UE was found to be 77.7% (κ = 0.698) for the first examiner and 64.30% (κ = 0.542) for the second examiner. Intraexaminer and interexaminer agreement were 0.971 and 0.924 for the UE, respectively. Moreover, interexaminer agreement for radiographic evaluation was 0.689. No significant difference was observed between the values of scoliosis and nonscoliosis patients. When the patients with a skinfold thickness of 16 mm or less and more than 16 mm were examined, the percentage accuracy of the UE was 80.43% (κ = 0.727) for the first group, whereas it was 72.91% (κ = 0.637) in the other group. CONCLUSION: We found the intraexaminer and interexaminer agreement for the UE of RS to be reliable. In radiographic evaluation of RS, the intraexaminer and interexaminer agreement were lower. These findings were also consistent with data from the literature. In conclusion, UE of RS is a reliable method; however, the results may vary when x-ray is considered as the gold standard.

Study Design. A prospective study of ultrasonographic evaluation (UE) results of the Risser sign (RS) in adolescents. Objective. This study aims to assess the efficiency of UE of RS, compare it with radiographic evaluation, and investigate the intraexaminer and interexaminer reliability of UE. Summary of Background Data. The use of ultrasound in orthopedic practice has a growing popularity. As a noninvasive radiological method, the evaluation of RS seems to be a promising alternative in patients suffering from scoliosis who require a long-term follow-up. Methods. This study consists of 142 patients (70 female and 72 male cases) aged between 10 and 17 years, with a mean age of 13.8 +/- 1.7 years. Menarche experience, body mass index, and skinfold thickness of the patients were recorded. Forty-five patients were found to have scoliosis. All ultrasonographic and radiographic evaluations were made by 2 blinded orthopedists. X-ray was considered as the gold standard. Results. Percentage accuracy of UE was found to be 77.7% (kappa = 0.698) for the first examiner and 64.30% (kappa = 0.542) for the second examiner. Intraexaminer and interexaminer agreement were 0.971 and 0.924 for the UE, respectively. Moreover, interexaminer agreement for radiographic evaluation was 0.689. No significant difference was observed between the values of scoliosis and nonscoliosis patients. When the patients with a skinfold thickness of 16 mm or less and more than 16 mm were examined, the percentage accuracy of the UE was 80.43% (kappa = 0.727) for the first group, whereas it was 72.91% (kappa = 0.637) in the other group. Conclusion. We found the intraexaminer and interexaminer agreement for the UE of RS to be reliable. In radiographic evaluation of RS, the intraexaminer and interexaminer agreement were lower. These findings were also consistent with data from the literature. In conclusion, UE of RS is a reliable method; however, the results may vary when x-ray is considered as the gold standard.

PURPOSE: To determine whether withdrawal of antiepileptic drugs (AEDs) in patients with psychogenic nonepileptic attacks (PNEAs) improves outcome. METHODS: Randomized controlled trial of AED withdrawal in patients with PNEAs. Patients were randomized to immediate or delayed (9 months) withdrawal of AEDs. We recorded spell frequency, changes in work status, use of emergency medical services, and psychological status at baseline, 9 months, and 18 months. RESULTS: Of 193 patients screened, 38 fulfilled entry criteria, 13 declined participation, and 25 were randomized. Fourteen patients were randomized to immediate withdrawal (IW) and 11 patients to delayed withdrawal (DW). There was a significant reduction in spell frequency from baseline to 9 months in the IW group but not in the DW group (p = 0.028). There was a significantly greater reduction in use of rescue medication in the IW group compared to the DW group between baseline and 9 months (p = 0.002). Emergency health care utilization dropped to zero in both groups by the end of the study. Psychological measures reflecting internal locus of control increased significantly more in the IW group (p = 0.005). DISCUSSION: Stringent diagnostic criteria and an increasing tendency for patients to be referred before AED prescription limited the recruitment and the power of the study. Our data nonetheless provide evidence that some outcomes are improved by AED withdrawal in patients with PNEAs.