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Thorax Aug 1994Weight loss is a well recognised feature of patients with emphysematous chronic obstructive pulmonary disease (COPD). It has been suggested that this weight loss could... (Comparative Study)
Comparative Study
BACKGROUND
Weight loss is a well recognised feature of patients with emphysematous chronic obstructive pulmonary disease (COPD). It has been suggested that this weight loss could be due to a hypermetabolic state resulting from the increased oxygen cost of breathing (OCB). To clarify the relation between resting energy expenditure (REE), nutritional state, and OCB these indices were measured in patients with respiratory impairment and an increased OCB due to COPD, scoliosis, and thoracoplasty.
METHODS
Eighteen patients (six COPD, six scoliosis, six thoracoplasty) of mean (SD) age 59.9 (8.6) years (8M, 10F) and six controls (45.5 (9.9) years; 2M, 4F) were studied. OCB was estimated by the addition of dead space to the breathing circuit and REE was measured by indirect calorimetry using a ventilated canopy system. Height, arm span, weight, triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), forced expiratory volume in one second (FEV1), and vital capacity (VC) were measured in all study subjects.
RESULTS
OCB was elevated in all patient groups (mean 7.0 ml/l) compared with controls (1.9 ml/l). All patients with COPD, four with scoliosis, three with thoracoplasty, and none of the controls were < 90% ideal body weight. Mean (SD) measured REE as % predicted (Harris-Benedict equation) was 103.8 (7.6) in patients with COPD, 105.5 (10.9) in those with scoliosis, 106.3 (6.9) in the thoracoplasty patients, and 103.3 (3.4) in controls. One patient with COPD, two with scoliosis, two with thoracoplasty, but no controls were hypermetabolic (REE > 110% predicted). In all groups there was a negative relation between OCB and lung function (OCB v FEV1 r = -0.83 in COPD, -0.62 in scoliosis, -0.67 in thoracoplasty, and -0.76 in controls). There was no correlation between REE and OCB or MAMC.
CONCLUSIONS
In patients with respiratory disease OCB (augmented ventilation) is related to lung function but not to REE. This is evidence against the hypothesis that hypermetabolism due to increased oxygen cost of breathing at rest is the sole or major cause of malnutrition in patients with lung disease.
Topics: Aged; Basal Metabolism; Female; Forced Expiratory Volume; Humans; Lung; Male; Middle Aged; Nutritional Status; Oxygen; Pulmonary Emphysema; Respiratory Function Tests; Scoliosis; Thoracoplasty; Vital Capacity; Weight Loss
PubMed: 8091323
DOI: 10.1136/thx.49.8.781 -
European Spine Journal : Official... Sep 2007A retrospective study of 21 patients with idiopathic scoliosis who underwent endoscopic thoracoplasty was done. The objective of the study was to report and assess the...
A retrospective study of 21 patients with idiopathic scoliosis who underwent endoscopic thoracoplasty was done. The objective of the study was to report and assess the morbidity and mid term outcomes of video-assisted thoracoplasty in idiopathic scoliosis. Patients with idiopathic scoliosis often present cosmetic complaints due to their rib deformity. This deformity may still exist after surgical correction of the main scoliotic curve. Endoscopic thoracoplasty has been reported as a safe method in limited cases of idiopathic scoliosis. Between 2002 and 2004, 21 patients underwent endoscopic anterior release and thoracoplasty for significant rib hump deformity associated with idiopathic scoliosis. Patients were operated on lateral position, with two endoscopic ports. Anterior release and rib resection were performed during the first stage, and instrumented posterior fusion was performed in a second stage. Patients were evaluated preoperatively, 1 week after surgery, 6 months after surgery and at their most recent follow-up with clinical and radiological measurement of the rib deformity. The mean age at surgery was 14.9 years old (range 13-17 years). The average Cobb's angle of the main scoliotic curve was 70 degrees (range 60 degrees -85 degrees). Average follow-up was 25 months (range 23-32 months). The mean number of resected ribs was five ribs (range 4-7) and the mean length of the resected rib was 4.2 cm (range 2.2-7 cm). Average operating time of endoscopic thoracoplasty (including anterior release) was 65 min (range 45-108 min). The mean preoperative height of rib hump deformity was 3.6 cm (range 2.5-5.5 cm). It was reduced to 1.5 cm at most recent follow-up. There was no significant thoracic pain necessitating medication postoperatively. No complications related to endoscopic anterior release and rib hump resection occurred in the series. Endoscopic thoracoplasty is a safe and reliable technique in idiopathic scoliosis. If indicated, the anterior release can be performed with video-assistance and the thoracoplasty can be performed on the same stage.
Topics: Adolescent; Female; Humans; Male; Radiography; Retrospective Studies; Ribs; Scoliosis; Thoracic Surgery, Video-Assisted; Thoracic Vertebrae; Thoracoplasty; Treatment Outcome
PubMed: 17356821
DOI: 10.1007/s00586-007-0340-z -
Journal of Thoracic Disease Mar 2014Most of thoracic surgery developed as a result of efforts to treat tuberculosis (TB). The role of surgical therapy has declined but the role of surgery in TB still... (Review)
Review
Most of thoracic surgery developed as a result of efforts to treat tuberculosis (TB). The role of surgical therapy has declined but the role of surgery in TB still remains in situations like diagnostic difficulties, persistent sputum positive state despite therapy and complications and sequel like haemoptysis, destroyed or bronchiectatic lungs or empyema with or without broncho-pleural fistula (BPF). Various procedures have a role according to the indication. Some of the procedures have become obsolete but lobectomy, pneumonectomy, thoracoplasty, decortication and open window thoracostomy continue to be relevant. Recent published series have demonstrated mortality ranging from 0% to 3.1%. Surgery for complications and sequel of pulmonary TB still remain an important intervention for alleviation of human misery.
PubMed: 24624283
DOI: 10.3978/j.issn.2072-1439.2013.12.19 -
Global Spine Journal Dec 2019A systematic review and meta-analysis. (Review)
Review
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVES
Pulmonary dysfunction is often advocated among the indications for surgical correction of adolescent idiopathic scoliosis (AIS). Previous studies have discussed the effect of scoliosis correction on respiratory function without reaching a definitive conclusion: Some showed that the respiratory function can improve after scoliosis surgery without defining the precise role of anterior, posterior, and combined approaches on this improvement; furthermore, the majority of these studies did not take normal growth into account. As a result, the role of surgery remains to be clarified. The object of the present study was to synthesize the current knowledge regarding changes in respiratory function after posterior corrective surgery for AIS.
METHODS
A comprehensive systematic search was performed to identify all relevant studies in the following electronic databases: MEDLINE, EMBASE, CINAHL (EBSCO). We focused on the studies (1) that discussed posterior fusion surgery for AIS without thoracoplasty, (2) that discussed comparisons of pre- and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume (%FEV), and (3) with minimum 2-year follow-up. Forest plots were depicted and value was calculated as a test for overall effect.
RESULTS
Ten studies (6 prospective and 4 retrospective studies) met our inclusion criteria. The overall effect showed that there was no significant difference in %FVC or %FEV between pre- and postoperative measurements (very low evidence).
CONCLUSIONS
Posterior correction surgery for mild to moderate AIS patients showed no significant improvement of postoperative respiratory function measured by relative, percent-predicted values at minimum 2-year follow-up.
PubMed: 31819853
DOI: 10.1177/2192568218811312 -
European Journal of Orthopaedic Surgery... Jul 2015Frequently, severe idiopathic scoliosis patients are first seen in a spine centre after years of deformity evolution, presenting with large curves, severe rib hump,...
Frequently, severe idiopathic scoliosis patients are first seen in a spine centre after years of deformity evolution, presenting with large curves, severe rib hump, shoulder and trunk imbalance and cardiorespiratory complications related to neglected scoliosis. Severe rigid idiopathic scoliosis has <25% of correction on bending films and major curve over 90°. Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications. Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results. Indications must be tailored by surgeons considering resources, deformity characteristics and patient's profile. Vertebral resection procedures may have potential neurological and clinical risks and should be one of the last treatment options performed by experienced surgical team. Neuromonitoring is essential during these procedures.
Topics: Adolescent; Child; Female; Humans; Internal Fixators; Male; Orthopedic Procedures; Scoliosis; Severity of Illness Index; Thoracoplasty; Traction; Young Adult
PubMed: 26033753
DOI: 10.1007/s00590-015-1650-1 -
Thorax Sep 1994
Topics: Drainage; Empyema, Pleural; Humans; Pleura; Ribs; Streptokinase; Thoracoplasty; Thoracostomy
PubMed: 7940417
DOI: 10.1136/thx.49.9.845 -
Clinical Orthopaedics and Related... May 2011Thoracic insufficiency syndrome represents a novel form of postnatal restrictive respiratory disease occurring in children with early-onset scoliosis and chest wall...
BACKGROUND
Thoracic insufficiency syndrome represents a novel form of postnatal restrictive respiratory disease occurring in children with early-onset scoliosis and chest wall anomalies. Expansion thoracoplasty improves lung volumes in children with thoracic insufficiency syndrome; however, how it affects lung development is unknown.
QUESTIONS/PURPOSES
Using a rabbit model of thoracic insufficiency syndrome, we evaluated the effect of expansion thoracoplasty on the response of biologic mechanisms in the alveolar microstructure.
METHODS
Using archived material from a previous experiment, 10 4-week-old New Zealand rabbits were divided into three groups: normal (n = 3), disease (n = 3), and treated (n = 4). Left ribs four to eight were tethered in seven rabbits at age 5 weeks to induce hypoplasia of the left hemithorax (disease). At age 10 weeks, four of these rabbits were treated by expansion thoracoplasty (treated). At age 24 weeks, lungs were excised and processed. Alveolar density and parenchymal airspace were measured on histologic sections. Immunohistochemistry was performed for vascular endothelial growth factor receptor 2 (angiogenesis), KI-67 (cell proliferation), and RAM-11 (macrophages).
RESULTS
Alveolar walls were poorly perfused and airspace fraction was larger (emphysematous) in disease rabbits than normal or treated rabbits. Immunohistochemistry provided inconclusive evidence to support the concept that pulmonary hypoplasia is induced by thoracic insufficiency syndrome and controlled by expansion thoracoplasty.
CONCLUSIONS
Treatment of thoracic insufficiency syndrome by expansion thoracoplasty may prevent emphysematous changes in the alveolar microstructure, thereby enhancing gas exchange.
Topics: Animals; Cell Proliferation; Disease Models, Animal; Immunohistochemistry; Ki-67 Antigen; Lung; Macrophages; Neovascularization, Physiologic; Nuclear Proteins; Pilot Projects; Rabbits; Respiratory Insufficiency; Ribs; Thoracoplasty; Thyroid Nuclear Factor 1; Time Factors; Tomography, X-Ray Computed; Transcription Factors; Vascular Endothelial Growth Factor Receptor-2
PubMed: 21424837
DOI: 10.1007/s11999-011-1807-0 -
The Indian Medical Gazette Oct 1942
PubMed: 29012638
DOI: No ID Found -
Edinburgh Medical Journal Mar 1925
PubMed: 29641073
DOI: No ID Found -
European Spine Journal : Official... Oct 2005Thoracoplasty in combination with spine fusion is an established method to address the rib cage deformity in idiopathic scoliosis. Most reports about thoracoplasty and...
Thoracoplasty in combination with spine fusion is an established method to address the rib cage deformity in idiopathic scoliosis. Most reports about thoracoplasty and scoliosis correction focused on Harrington or CD instrumentation. We report a retrospective analysis of 21 consecutive patients, who were treated with pedicle screw instrumentation for idiopathic thoracic scoliosis and concomitant thoracoplasty. Minimal follow up was 24 (24-75) months. Indication for thoracoplasty was clinical rib prominence of more than 15 degrees . In average there was a 44% correction of clinical rib hump, from 18 (15-25 degrees ) to 10 degrees (0-18 degrees ) (p<0.0001) and a 40% correction of radiological rib hump, from 15 (5-20 degrees ) to 9 degrees (2-15 degrees ) (p<0.0001). The preoperative pulmonary function, accessed by forced vital capacity (FVC) and one-second forced expiratory volume (FEV1), remained unchanged at the last follow up. The distal end of fusion was the end vertebra of the curve in 83.3% and the end vertebra plus one in 16.7% of the patients. There was a 68% correction of instrumented primary thoracic curves, from 60 (45-85 degrees ) to 19 degrees (5-36 degrees ) (p<0.0001), and a 45% correction of non-instrumented secondary lumbar curves, from 40 (28-60 degrees ) to 22 degrees (8-38 degrees ) (p<0.0001). Apical vertebral rotation (AVR) of the thoracic curves improved 54%, from 24 (10-35 degrees ) to 11 degrees (5-20 degrees ) (p<0.0001). The tilt of lowest instrumented vertebra (LIV) improved 68%, from 28 (20-42 degrees ) to 9 degrees (3-20 degrees ) (p<0.0001). There was no significant change in sagittal profile of the spine. Analysis with SRS-24 questionnaire showed that the majority of the patients were very satisfied with the outcome. A matched control group (n=21) operated by the same surgeon with the same operation technique but without concomitant thoracoplasty was chosen for comparison. The scoliosis correction in the two groups was comparable. The patients without thoracoplasty had 37% spontaneous improvement of the clinical rib hump.
Topics: Bone Screws; Female; Follow-Up Studies; Humans; Internal Fixators; Male; Radiography; Retrospective Studies; Scoliosis; Surveys and Questionnaires; Thoracic Vertebrae; Thoracoplasty; Treatment Outcome
PubMed: 16096773
DOI: 10.1007/s00586-005-0977-4