Search

This article explores the lived experience of women with suspected cytomegalovirus (CMV) infection during pregnancy. The study conducted interviews with Australian women who had undergone serological testing for CMV during pregnancy. The findings revealed that participants had a lack of awareness about CMV, experienced high levels of stress and anxiety, supported screening for CMV but acknowledged that it may not be wanted by everyone, and relied on personal support and access to knowledgeable healthcare professionals. The study emphasizes the need for improved knowledge among healthcare professionals and public awareness before implementing widespread serological screening for CMV during pregnancy. [Extracted from the article]

Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides are rare small vessel vasculitides of unknown cause. The pathogenic role of MPO-ANCA in the vasculitides has been supported using various animal models, with B-cells playing a role in the disease pathogenesis. Pregnancy in the presence of an autoimmune disease such as vasculitis is often associated with significant morbidity. Little is known about the outcomes when women present with de novo vasculitis during pregnancy, and the appropriate management of such presentations is unclear. We describe a case of a 33-year-old female presenting in her second pregnancy with new onset ANCA vasculitis at 12 weeks' gestation. She was successfully treated with prednisolone and rituximab, and delivered a healthy 2.8 kg boy at 36 weeks' gestation with no clinical manifestations of vasculitis or neutropenia in the neonate. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence supporting the use of valaciclovir to reduce fetal infection after maternal primary cytomegalovirus (CMV) infection has stimulated interest in routine CMV serological screening in pregnancy. It is important to understand the healthcare consumer perspective of a CMV infection during pregnancy to minimize unintended harms of screening., Methods: We conducted a qualitative study using semi-structured interviews with Australian women who had a lived experience of CMV infection following serological testing during pregnancy. Participants were recruited via social media and healthcare consumer networks, and purposively selected to capture a range of perinatal outcomes. Interview transcripts were analyzed using inductive content analysis., Results: Twelve participants were interviewed: 6 had a live birth, 4 had terminations of pregnancy, 1 had a neonatal death and 1 was pregnant at the time of interview. Four major categories emerged from the analysis. Women reported a lack of CMV awareness among themselves, their social networks, and among their health care providers. The participants described their experience as "hard" and "stressful". Uncertainty and variability characterized their clinical decision-making process. The pregnancy and postpartum periods were marked by ongoing anxiety about the long-term impacts of CMV. Women supported screening for CMV, decision making and reproductive choice, but acknowledged that routine testing may not be desired by everyone and may increase stress and terminations of pregnancy. Important coping strategies included obtaining support from partners, family, and other families with lived experience of CMV, as well as having access to knowledgeable and sensitive healthcare professionals., Conclusion: Serological diagnosis of maternal CMV infection during pregnancy can have severe and prolonged psychological impacts on parents, regardless of the pregnancy outcome. Improving healthcare professionals' knowledge and public awareness are essential before widespread serological screening can be responsibly introduced. Healthcare administrators that are considering implementing a prenatal screening program for secondary prevention of fetal CMV infection should pay attention to consumer perspectives to minimize unintended harms to women and their families., (© 2024 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.)

We present a unique case of a 44-year-old woman who presented at 29 weeks' gestation with proximal limb pain and elevated creatine kinase. This occurred in the background of premature cataracts, atrial fibrillation and abnormal liver function. Clinical, pathological and neurodiagnostic findings supported a diagnosis of myotonic dystrophy, confirmed by genetic testing which revealed dystrophia myotonica protein kinase gene expansion. Muscle biopsy found both recent necrotising and chronic myopathic processes. Following delivery, the mother's myalgia resolved and creatine kinase quickly declined. The fetus was diagnosed with congenital myotonic dystrophy. We review the impact of myotonic dystrophy on pregnancy and discuss potential explanations for this patient's clinical course. This case emphasises the importance of considering myotonic dystrophy as a differential diagnosis in the right clinical context and the need for pre-pregnancy assessment and genetic counselling in women with known myotonic dystrophy., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objectives: To evaluate fetal heart rate (FHR) patterns during sleep in pregnancies complicated by preterm fetal growth restriction (FGR). To determine whether co-existing sleep-disordered breathing (SDB) impacts on acute FHR events or perinatal outcome., Design: Observational case control study., Setting and Population: Women with preterm FGR and gestation-matched well grown controls (estimated fetal weight above the 10th percentile with normal Doppler studies); tertiary maternity hospital, Australia., Methods: A polysomnogram, a test used to measure sleep patterns and diagnose sleep disorders, and concurrent cardiotocography (CTG), were analysed for respiratory events and FHR changes., Main Outcome Measures: Frequency of FHR events overnight in FGR cases versus controls and in those with or without SDB., Results: Twenty-nine patients with preterm FGR and 29 controls (median estimated fetal weight 1st versus 60th percentile, P < 0.001) underwent polysomnography with concurrent CTG at a mean gestation of 30.2 weeks. The median number of FHR events per night was higher among FGR cases than among controls (3.0 events, interquartile range [IQR] 1.0-4.0, versus 1.0 [IQR 0-1.0]; P < 0.001). Women with pregnancies complicated by preterm FGR were more likely than controls to be nulliparous, receive antihypertensive medications, be supine at sleep onset, and to sleep supine (32.9% of total sleep time versus 18.3%, P = 0.03). SDB was common in both FGR and control pregnancies (48% versus 38%, respectively, P = 0.55) but was generally mild and not associated with an increase in overnight FHR events or adverse perinatal outcome., Conclusions: Acute FHR events overnight are more common in pregnancies complicated by preterm FGR than in pregnancies with normal fetal growth. Mild SDB was common in late pregnancy and well tolerated, even by fetuses with preterm FGR., Tweetable Abstract: Mild sleep-disordered breathing seems well tolerated even by highly vulnerable fetuses., (© 2022 John Wiley & Sons Ltd.)

Links between supine "going to sleep" position and stillbirth risk have led to campaigns regarding safe maternal sleep position. This study profiles the distribution of sleep positions overnight and relationships to sleep onset position during pregnancy, and the relationships between supine sleep, sleep-disordered breathing (SDB), and pregnancy outcomes. Data from three prospective cohort studies evaluating SDB in healthy and complicated pregnancies were pooled. All participants underwent one night of polysomnography in late pregnancy and birth outcome data were collected. 187 women underwent polysomnography at a median gestation of 34 weeks'. The left lateral position was preferred for falling asleep (52%) compared to supine (14%), but sleep onset position was the dominant sleep position overnight in only half (54%) of women. The median percentage of sleep time in the supine position was 24.2%; women who fell asleep supine spent more time supine overnight compared to those who began non-supine (48.0% (30.0,65.9) vs. 22.6% (5.7,32.2), p < .001). Women with growth-restricted fetuses were more likely to fall asleep supine than those with well-grown fetuses (36.6% vs. 7.5%, p < .001). Positional SDB was observed in 46% of those with an RDI ≥ 5. Sleep onset position was the dominant position overnight for half of the sample, suggesting that sleep onset position is not always a reliable indicator of body position overnight. Supine sleep was related to fetal growth restriction and birthweight at delivery, though causality cannot be inferred. It is critical that we pursue research into verifying the important relationship between supine sleep and increased stillbirth risk, and the mechanisms behind it., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In Australia, a significant proportion of stillbirths remain unexplained. Recent research has highlighted nocturnal maternal behaviours as potentially modifiable contributors. This study determined whether sleep-related behaviours including sleep position and sleep-disordered breathing adversely affect fetuses overnight, in both uncomplicated pregnancies and those at increased risk due to hypertensive disorders or fetal growth restriction (FGR). All participants underwent polysomnography with time-synchronized fetal heart rate (FHR) monitoring (cardiotocography - CTG) in late pregnancy. CTGs were analysed for abnormal FHR events, including decelerations and reduced variability, by two blinded observers and exported into the sleep study to temporally align FHR events with sleep behaviours. For each FHR event, 10 control epochs with normal FHR were randomly selected for the same participant. Conditional logistic regression assessed the relationships between FHR events and sleep behaviours. From 116 participants, 52 had a total of 129 FHR events overnight; namely prolonged decelerations and prolonged periods of reduced variability. Significantly more FHR events were observed in women with FGR and/or a hypertensive disorder compared with uncomplicated pregnancies (P = 0.006). FHR events were twice as likely to be preceded by a change in body position within the previous 5 min, compared with control epochs (P = 0.007), particularly in hypertensive pregnancies both with and without FGR. Overall, FHR events were not temporally related to supine body position, respiratory events or snoring. Our results indicate that most fetuses tolerate sleep-related stressors, but further research is needed to identify the interplay of maternal and fetal conditions putting the fetus at risk overnight. KEY POINTS: Maternal sleep behaviours including supine position and sleep-disordered breathing are potential contributors to stillbirth but much of this work is based on self-reported data. Using time-synchronized polysomnography and cardiotocography, we found that nocturnal fetal heart rate decelerations were more likely to be preceded by a change in body position compared with epochs containing normal fetal heart rate, particularly in hypertensive pregnancies with or without fetal growth restriction. There was no temporal relationship between maternal sleeping position, snoring or apnoeic events and an abnormal fetal heart rate overnight. We conclude that most fetuses can tolerate sleep-related stressors with no evidence of fetal heart rate changes indicating compromised wellbeing. Further work needs to identify how sleep behaviours contribute to stillbirth risk and how these intersect with underlying maternal and fetal conditions., (© 2022 The Authors. The Journal of Physiology © 2022 The Physiological Society.)

The use of complementary visualization and measurement techniques allowed accurate description and quantification of changes in the intestinal mucosal architecture and provided a comprehensive outlook on the dynamics of remodelling and maturation processes of the mucosal layer taking place in the small intestine of piglets from birth to weaning. The aim of the study was to examine the early postnatal development of the small intestine in pigs. Three techniques were used: scanning electron microscopy (measurements of villus density and shape, height of enterocytes and microvilli, cell exfoliation, and location of extrusion zones), optical microscopy (cross section, measurement of structures: villus length and width; crypt depth; mucosal thickness), and confocal microscopy (cell localization, apoptosis, exfoliation and migration). The postnatal development of the mucosal layer of the small intestine was reflected in changes in the density, length, width, and shape of villi, crypt depth, replacement of enterocyte population, and arrangement. The presence of deep transverse furrows on villus corpus and vacuolated fetal-type enterocytes in the mucosal layer of the small intestine, which are able to engulf large amounts of colostrum shortly after birth, appears to play an important role in the observed phenomenon of straightening of the villus height and increasing of the villus diameter shortly after birth. We hypothesized that the intestinal mucosal layer is compressed before birth and ready to unfold within a short time after birth.

The relationships between six bacterial symbionts of the entomopathogenic nematodes Heterorhabditis bacteriophora and Heterorhabditis megidis from Poland to species and subspecies of the genus Photorhabdus were evaluated. This study was based on phylogenetic analysis of sequence data of five genes: 16S rRNA, gyrB, recA, gltX, and dnaN. The bacteria were also characterized phenotypically by biochemical and physiological tests. Our results have revealed that the Photorhabdus strains isolated from H. megidis belong to P. temperata, subsp. temperata and subsp. cinerea. Isolates from H. bacteriophora represent P. luminescens subs. kayaii and P. temperata subs. cinerea. This study for the first time provides evidence for H. bacteriophora and P. temperata subsp. cinerea symbiotic association. In addition, we tested whether the microsymbionts of the Polish H. bacteriophora and H. megidis isolates support the development of non-native nematode host population and colonization of their infective juveniles. It has been shown that the studied Photorhabdus strains can readily swap their nematode host, both at intra- and interspecies level. It supports the hypothesis of different symbiotic associations in the Heterorhabditis-Photorhabdus lineage.

Our concept of nucleic acid biology has advanced dramatically over the past two decades, with a growing appreciation that cell-free DNA (cfDNA) fragments are present in all body fluids including plasma. In no other field has plasma DNA been as rapidly translated into clinical practice as in noninvasive prenatal testing (NIPT) for fetal chromosome abnormalities. NIPT is a screening test that requires confirmation with diagnostic testing, but other applications of cfDNA provide diagnostic information and do not require invasive testing. These applications are referred to as noninvasive prenatal diagnosis (NIPD) and include determination of fetal sex, blood group and some single gene disorders. As technology advances, noninvasive tests based on cell-free nucleic acids will continue to expand. This review will outline the technical and clinical aspects of NIPT and NIPD relevant to the daily practice of maternity carers., (Copyright © 2017. Published by Elsevier Ltd.)

Dreaming during anaesthesia is defined as any recalled experience (excluding awareness) that occurred between induction of anaesthesia and the first moment of consciousness upon emergence. Dreaming is a commonly-reported side-effect of anaesthesia. The incidence is higher in patients who are interviewed immediately after anaesthesia (approximately 22%) than in those who are interviewed later (approximately 6%). A minority of dreams, which include sensory perceptions obtained during anaesthesia, provide evidence of near-miss awareness. These patients may have risk factors for awareness and this type of dreaming may be prevented by depth of anaesthesia monitoring. Most dreaming however, occurs in younger, fitter patients, who have high home dream recall, who receive propofol-based anaesthesia and who emerge rapidly from anaesthesia. Their dreams are usually short and pleasant, are related to work, family and recreation, are not related to inadequate anaesthesia and probably occur during recovery. Dreaming is a common, fascinating, usually pleasant and harmless phenomenon.

The unique feature of enterocytes in newborn mammals is the presence of an apical canalicular system (ACS) leading to production of large vacuoles, important for colostral macromolecule uptake. The vacuolated fetal-type enterocytes (VFE) enable transfer of colostral and milk proteins from the intestinal lumen across the epithelium without loosing their biological activity. First VFE are observed in the pig and lamb fetuses in the second trimester of pregnancy, located at the upper part of villi in the proximal region of the fetal small intestine and subsequently in the middle and distal regions. After birth the VFE are replaced with enterocytes lacking ACS. The present study aimed to investigate the depletion of VFE in the small intestine in the sow reared pig neonates during the first postnatal weeks using scanning electron microscopy (SEM). The SEM analysis demonstrated the gradual disappearance of vacuolated enterocytes in time. VFE remained in the jejunum for a few days after birth, whereas in the duodenum single VFE were present only at birth. In the proximal jejunum, the VFE were localized in the upper part of the villi, and disappeared until the day 3 of life. VFE were present in the mid and distal jejunum, and diminished gradually until day 14 of life. By the day 21 of life, the vacuolated cells were not observed neither in the jejunum nor ileum. In conclusion, morphology analysis of pig small intestinal mucosa suggests that replacement of fetal type vacuolated enterocytes is resumed within 21 days after birth.

Background: Dreaming reported after anesthesia remains a poorly understood phenomenon. Dreaming may be related to light anesthesia and represent near-miss awareness. However, few studies have assessed the relation between dreaming and depth of anesthesia, and their results were inconclusive. Therefore, the authors tested the hypothesis that dreaming during anesthesia is associated with light anesthesia, as evidenced by higher Bispectral Index values during maintenance of anesthesia., Methods: With approval, 300 consenting healthy patients, aged 18-50 yr, presenting for elective surgery requiring relaxant general anesthesia with a broad range of agents were studied. Patients were interviewed on emergence and 2-4 h postoperatively. The Bispectral Index was recorded from induction until the first interview. Dream content and form were also assessed., Results: Dreaming was reported by 22% of patients on emergence. There was no difference between dreamers and nondreamers in median Bispectral Index values during maintenance (37 [23-55] vs. 38 [20-59]; P=0.68) or the time at Bispectral Index values greater than 60 (0 [0-7] vs. 0 [0-31] min; P=0.38). Dreamers tended to be younger and male, to have high home dream recall, to receive propofol maintenance or regional anesthesia, and to open their eyes sooner after surgery. Most dreams were similar to dreams of sleep and were pleasant, and the content was unrelated to surgery., Conclusions: Dreaming during anesthesia is unrelated to the depth of anesthesia in almost all cases. Similarities with dreams of sleep suggest that anesthetic dreaming occurs during recovery, when patients are sedated or in a physiologic sleep state.

Apoptosis is a fundamental process in the development of the fast growing intestinal mucosa. Apoptotic cells are present along the whole length of the villi and in the crypts. The mechanisms involved in the induction of apoptosis in the gut mucosa are still unknown. Cytokines are believed to play a role in auto- and paracrine models because the cells are dying in so-called "packets" containing neighboring cells. In the rapidly developing gut of neonates, the apoptosis rate is transiently reduced in the first days of life, enhancing the growth of mucosa. Afterwards, apoptosis plays a role in the exchange of the enterocyte population, facilitating maturation of the mucosa. The presence of autophagic cells has been confirmed for the first time in the developing gut. Deprivation of growth factors during feeding artificial milk formula led to an increased apoptosis rate. Supplementation with leptin reduced cell apoptosis and increased the mitosis-to-apoptosis ratio. Autophagy was also diminished. The key to healthy gut mucosa growth in early life, especially in fast-growing animals, is colostrum, which supplies nutritional and defensive components together with supplementary growth factors, cytokines and hormones essential for growth and maturation of gut mucosa.

Modifications in the structure of gastrointestinal mucosa is often used to evaluate gut function for instance during the development or in response to particular food components. Scanning electron microscopy (SEM) gives a chance to observe the surface of the gut epithelium in three dimensions. However, this technique is seldom used due to technical difficulties. The present study attempted to investigate the intestinal mucosa structure changes in the postnatal pig using light and scanning electron microscopy technique. Experiments were carried out on sow reared piglets from birth until 38 days of age. Piglets were sacrificed at birth and at the 3(rd), 7(th), 21(st) and 38(th) day of life. The entire gastrointestinal tract was immediately harvested and the whole thickness tissue samples were taken from the duodenum, jejunum and ileum for optical and scanning electron microscopy. SEM analyses corroborated with histometry made by optical microscopy. Moreover, a number of shape modifications of the villi and its surface have been observed. The development changes in small intestine mucosa during the first 3 weeks were manifested in shape, size and density of villi. In conclusion, the structure of small intestinal mucosa undergoes profound structural changes. SEM gives a new dimension in the investigation of gut mucosa.

The objective of the presented study was to investigate the adsorption of Cu, Co, Mn, Zn, Cd and Mn on A-type zeolite. The isotherms for adsorption of metals from their nitrates were registered. The following adsorption constants K of metals were found: 162,890, 124,260, 69,025, 16,035, 10,254, and 151 [M(-1)] for Cu, Co, Mn, Zn, Cd, and Ni, respectively, for the concentration range 10(-4)-10(-3) M. On the other hand, the investigation of pH influence on the distribution constants of metals showed that the adsorption of metals proceeds essentially through an ion-exchange process, surface hydrolysis, and surface complexation. The supplementary results from DRIFT, scanning electron microscopy, and X-ray diffraction methods confirmed the presumption about the possible connection between the electronic structure of divalent ions and their adsorption behavior, showing that ions with d5 and d10 configurations such as Mn2+, Zn2+, Cd2+, with much weaker hydrolytic properties than Cu2+ and Ni2+, strongly interact with the zeolite framework and therefore their affinity to the zeolite phase is much stronger when compared with that of the Ni2+ ion, but at the same time not as strong as the affinity of the Cu2+ ion, the latter forming a new phase during the interaction with zeolite framework. For Zn2+, during inspection of the correlation between the proton concentration H/Al and zinc concentration Zn/Al on the zeolite surface, the formation of the surface complex [triple bond]S-OZn(OH) was proposed. A correlation between the heterogeneity of proton concentrations H/Al on Me-zeolite surfaces and the hydrolysis constants pKh of Me2+ ions was found.

The authors analysed 841 patients (83% girls and 17% boys) with adolescent idiopathic scoliosis. 678 patients (group I) were treated with the Harrington technique and 163 patients (group II) were treated using multisegmental instrumentation. Follow-up time in group I was on average 14.2 years, and 28 months in group II. Preoperative assessment of patients in group was based on clinical and radiological examination. Assessment of the spine was mainly based on coronal radiogram done in an upright position and lateral side-bending radiograms in a supine position. Traction and lateral X rays were rarely taken into account in this study. The fusion area was decided according to the end vertebrae of the structural curves. The caudal end of the fusion area was identified using Harrington's stable zone. The curves were classified in accordance with the SRS suggestions. Taking into account the apex of the curve, the deformations were classified into: cervico-thoracic, thoracic, thoraco-lumbar, lumbar and lumbo-sacral curves. In group II the triplanar (3D) character of the deformity was taken into account. In the coronal plane the upper and lower stable vertebra of the major structural curves were identified using the CSVL (Central Sacral Vertical Line) based on long films (70 cm x 110 cm) with and without traction. Lumbar curve was classified as mild, moderate, severe according to CSVL. In the axial plane vertebral rotation was assessed according to Nash and Moe method. A careful analysis of lateral radiograms in the upright standing position was performed. Lateral radiograms were performed also in maximal flexion and hyperextension of the spine to obtain a dynamic evaluation of the sagittal plane. Conoral radiograms with maximal rotation of the trunk to assess mobility of the caudad segments of the deformity. Classification of the scoliotic deformity based on its triplanar character included: thoracic curves (King III, IV, V types), double major (thoracic and lumbar), "false" double major curve (thoracic and lumbar) King type II, thoracolumbar/lumbar curves--the main curve is thoracolumbar lumbar/thoracolumbar curves--the main curve is lumbar--10 degrees the thoracolumbar component--King type I triple major curve--all curves have similar structural changes. Correct identification of the type of scoliosis, assessment of structural changes in the frontal, sagittal and axial plane (three dimensional 3D) and analysis of the size and correctiveness of the lumbar curve and all parameters which play a key role in rational preoperative planning. Redefining or at least maintaining lumbar lordosis is far more important than correction of thoracic kyphosis.

Authors presented in comprehensive form updated knowledge concerning reasons and mechanisms of musculoskeletal back pain nonspecific symptom which in majority of cases, provides only little inside into the nature of the underlying problem. The physician must however find sufficient time to educate the patient as to the nature of this disorder and likely course during treatment. Understanding the source and mechanisms of the patients pain allows the physician and patient to approach the problem rationally with mutual confidence. The basic aim of the physician is exact identification of the anatomic source of pain and exclude the possibility of underlying systemic or malignant process that might threaten the patient's life. The musculoskeletal system consists of the bones and articulations, ligaments, muscles and tendons, that connect and manipulate them within spinal column. All of these tissues are richly innervated and specific biomechanical conditions cause, that lumbar part of the spine and lumbosacral junction are extremely susceptible to direct and indirect affected by a spectrum of reasons causing pain. The pathomechanism of the pain originating within the facet joints, bone and periosteum, paraspinous muscles and tendons, intervertebral disks, posterior longitudinal ligament and dorsal root ganglion was discussed. Although in majority of causes it possible to control localized pain by means of conservative treatment, however in some patients (0.5%-1%) surgery is needed to decompress neurologic structures, restore stability, and eliminate pain.

Currently recommended management for low back pain in adults is presented. The algorithm consists of two phases. In a patient presenting acute low back pain with no previous history thorough clinical evaluation (phase I) should aim at exclusion of cauda equina syndrome, fracture, neoplasm, infection, progressive neurological deficit, or chronic pain syndrome. If none of these condition is responsible for low back pain 4-6 weeks therapy depending on the severity of symptoms should be commenced. Then clinical reevaluation is indicated and if pain persists patient should be referred to a specialist (phase II). Previous diagnosis and treatment should be reviewed critically; if found appropriate the treatment might be repeated during phase II. Primary sources of low back pain as herniated nucleus pulposus, unremitting low back pain (segmental instability), spondylolysis, isthmic spondylolisthesis degenerative spondylolisthesis with spinal stenosis should be identified and appropriate treatment (surgical or conservative) undertaken. Patient education is an important component of phase II. In general, phase II of the algorithm aims at returning the patient to full psychophysical activity and at prevention of low back pain recurrence.

Authors present current knowledge about incidence and etiologic factors in idiopathic scoliosis (IS). Most data about incidence are based on screening examination in school children. Amount of patient with IS is related to the method of evaluation and experience of examiner. There is 1.9% to 3% cases in whole population if scoliosis is assumed as much as 10 degrees of Cobb angle (SRS). Etiology of IS is still in doubt despite of many investigations. There are many abnormalities in tissues but most of them probably secondary to this process. Etiology is multifactorial with dominance of inheritance. There are many genes responsible for occurrence of IS but genetic trait is still unknown.

This presentation aim was to provide correct answer in question of range of spondylodesis (both proximal and distal levels) in surgical treatment of idiopathic scoliosis with multisegmental instrumentation. The postoperative evaluation o 88 patients (77 girls and 11 boys) was done according to King and Moe classification. Average patients age was 13.8 years (11.4-17.1) with 18.2 months (12-29) follow-up. In 53 cases it was longer than 2 years. The identification of the curve pattern in both the coronal and sagittal planes will allow you to decide which curves to fuse. In the choice of upper fusion level one should keep attention to shoulder balance and presence of superior junctional kyphosis, extending than range of the fusion up to T2. In the lower level there is important to keep distal fusion mass in vertical alignment transsected by CSL (just like in the upper end in thoracic spine) to preserve spine compensation and remaining as many sa possible mobile spine segments below the fusion.

Results of operative treatment of idiopathic scoliosis in 88 patients (77 girls and 11 boys) with an average follow-up of 18 months have been presented. Basic principles of surgical procedure and most commonly made errors are demonstrated on the basis of authors' experience and data from the literature. The method of strategic vertebrae selection for hook implantation depending on scoliosis type are discussed. Differences in surgical technique in respect to idiopathic lordoscoliosis or kyphoscoliosis have been highlighted.