Preoperative predictors of postoperative pulmonary complications in neuromuscular scoliosis.

BACKGROUND: Neuromuscular scoliosis (NMS) is associated with progressive restrictive lung disease and an increased risk of prolonged ventilation following surgery. This study reports the experiences of a single institution and evaluates whether preoperative pulmonary function tests (PFT) can predict the development of postoperative pulmonary complications. METHODS: Correlations between preoperative PFT (forced expired volume in 1 s, FEV(1); forced vital capacity, FVC) findings and postoperative pulmonary complications were searched for among 74 NMS patients who underwent surgical correction at our medical center from 2002 to 2008. RESULTS: Thirty-seven patients (50%) developed a pulmonary complication. The independent factors found to contribute to the development of a pulmonary complication were: FEV(1) <40% of the predicted value (P = 0.007), FVC <39.5% of the predicted value (P = 0.005), a larger Cobb angle (>69°) (P = 0.002), and older age (>16.5 years) (P = 0.027). Of these 37 patients, 6 needed postoperative ventilation. PFT findings found to be independently associated with the need for postoperative ventilation were: FEV(1) <40% of the predicted value (P = 0.017) and FVC <39.5% of the predicted value (P = 0.015). CONCLUSIONS: NMS patients with a preoperative FVC of <39.5% of the predicted value, an FEV(1) <40% of the predicted value, a Cobb angle of >69°, or age >16.5 years were found to be more likely to develop a postoperative pulmonary complication.

Successful removal of indigested shell using a rigid esophagoscope and a pneumatic lithotriptor.

Foreign body ingestion is a commonly encountered clinical problem in pediatric emergency cases. The authors report a case of an esophageal foreign body caused by the accidental ingestion of a shell in an 8-month-old girl. Endoscopic removal was attempted but failed because of the sharp margin of the shell and caused it to be deeply impacted into the esophageal wall. Accordingly, a pneumatic lithotriptor was inserted through a rigid esophagoscope and used to fragment the shell.

Predictability of pulmonary function tests for intra- and post-operative cardiopulmonary complications of corrective surgery to treat scoliosis: a retrospective study.

BACKGROUND: This study was conducted to confirm the predictive power of preoperative pulmonary functions tests (PFTs) for intra- and post-operative cardiopulmonary complications during corrective surgery for scoliosis. METHODS: A retrospective review of hospital charts of patients who underwent surgical correction for scoliosis and/or kyphosis at our medical center between September 2002 and September 2008 was performed. RESULTS: A total of 141 patients were enrolled in this study. The overall intra- and post-operative cardiopulmonary complication rate was 33.3% (47/141). There were 32 and 19 complications related to pulmonary issues (22.7%) and cardiovascular complications (13.5%), respectively. The complication rate of neuromuscular scoliosis (NMS) was 47.3% (35/74), while that of non-neuromuscular scoliosis (NNMS) was 17.9% (12/67). The cardiopulmonary complication rates of groups with FEV1 volumes below 1 L, 1-1.5 L, 1.5-2 L and over 2 L were 66.7% (18/27), 43.3% (13/30), 20.0% (7/35) and 18.4% (9/49), respectively. The group with FEV1 volumes below 1 L showed a significantly increased risk when compared to the group with FEV1 volumes over 2 L (P<0.05, Odds ratio = 5.15, multivariate logistic regression test). The cardiopulmonary complication rates of groups with FVC volumes below 1 L, 1-1.5 L, 1.5-2 L and over 2 L were 70.8% (17/24), 37.5% (9/24), 33.3% (11/33) and 16.7% (10/60), respectively. Additionally, the group with FVC volumes below 1 L showed significantly increased risk when compared to a group with FVC volumes greater than 2 L (P<0.001, Odds ratio = 8.0, multivariate logistic regression). CONCLUSIONS: The correction for NMS carries a higher complication rate than NNMS. Intra- and post-operative cardiopulmonary complication rates of a group with FEV1 or FVC volumes below 1 L were higher than the rates of groups with FEV1 and FVC volumes greater than 2 L.