Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society.

In a prospective study by the Scoliosis Research Society, 286 girls who had adolescent idiopathic scoliosis, a thoracic or thoracolumbar curve of 25 to 35 degrees, and a mean age of twelve years and seven months (range, ten to fifteen years) were followed to determine the effect of treatment with observation only (129 patients), an underarm plastic brace (111 patients), and nighttime surface electrical stimulation (forty-six patients). Thirty-nine patients were lost to follow-up, leaving 247 (86 per cent) who were followed until maturity or who were dropped from the study because of failure of the assigned treatment. The end point of failure of treatment was defined as an increase in the curve of at least 6 degrees, from the time of the first roentgenogram, on two consecutive roentgenograms. As determined with use of this end point, treatment with a brace failed in seventeen of the 111 patients; observation only, in fifty-eight of the 129 patients; and electrical stimulation, in twenty-two of the forty-six patients. According to survivorship analysis, treatment with a brace was associated with a success rate of 74 per cent (95 per cent confidence interval, 52 to 84) at four years; observation only, with a success rate of 34 per cent (95 per cent confidence interval, 16 to 49); and electrical stimulation, with a success rate of 33 per cent (95 per cent confidence interval, 12 to 60).(ABSTRACT TRUNCATED AT 250 WORDS)

Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society.

In a study conducted by the Scoliosis Research Society, 159 girls with a mean age of thirteen years (range, ten to fifteen years) who had adolescent idiopathic scoliosis were followed prospectively until skeletal maturity or until the curve had increased 6 degrees or more. All patients had had an initial curve of 25 to 35 degrees and an apical level between the eighth thoracic and first lumbar vertebrae, inclusive. Of the 159 patients, 120 were observed without treatment and thirty-nine were managed with lateral electrical surface stimulation. The curve progressed at least 6 degrees in eighty patients. There was no apparent difference in the outcome between the patients who were managed with observation only and those who were given electrical stimulation. Logistic regression analysis was performed to determine which of eleven factors were predictive of progression of the scoliotic curve. A Risser sign of 0 or 1, an apical level cephalad to the twelfth thoracic vertebra, and an imbalance of ten millimeters or less were found to be independently prognostic of progression of more than 6 degrees. A prognostic model that included these three factors and chronological age allowed correct classification of the curve as either progressive or non-progressive in 81 per cent of these patients who had a thoracic or thoracolumbar adolescent idiopathic scoliosis. The positive predictive value was 82 per cent, the negative predictive value was 80 per cent, and the sensitivity and specificity were each 81 per cent.

Ofloxacin versus trimethoprim-sulphamethoxazole in acute cystitis.

The clinical and bacteriological efficacy and adverse reactions of ofloxacin vs trimethoprim-sulphamethoxazole were investigated in a double-blind, randomised study in 250 female patients (125 in each group) with acute, uncomplicated lower urinary tract infections. The dosages of ofloxacin and trimethoprim-sulphamethoxazole were 100mg and 160mg + 800mg twice daily, respectively. The duration of therapy was 3 days. 81% of the patients had significant bacteriuria. Escherichia coli was isolated in 76% and Staphylococcus saprophyticus in 11% of the infections. The bacteriological elimination, clinical cure and improvement rates of the evaluable patients on ofloxacin treatment were 92 and 95%, respectively. The corresponding figures on trimethoprim-sulphamethoxazole therapy were 88 and 90%. Adverse reactions were clinically unimportant, and none of the patients had to stop treatment. Mild and transient side effects, mainly from the gastrointestinal tract, central nervous system and skin, were reported by 19 and 22% of the patients in the ofloxacin and trimethoprim-sulphamethoxazole groups, respectively. None of the differences in clinical and bacteriological efficacy and side effects of ofloxacin vs trimethoprim-sulphamethoxazole were statistically significant. Ofloxacin appears to be an appropriate antibiotic for short term therapy of acute, uncomplicated, lower urinary tract infections, comparing favourably with trimethoprim-sulphamethoxazole treatment in this study.

Pain relief in labor by transcutaneous electrical nerve stimulation. Testing of a modified stimulation technique and evaluation of the neurological and biochemical condition of the newborn infant.

In this prospective randomized study of pain relief in labor, the effect of transcutaneous electrical nerve stimulation (TNS) performed over both the low-back and suprapubic region was evaluated and compared with a control group not receiving TNS. Both high frequency and pulse train TNS were used. The study included 24 induced labors. In the TNS group, conventional methods were added when needed, while in the control group only conventional methods were used. Assessment of low-back and suprapubic pain was performed by the parturient each hour during the first stage. In the TNS group most of the parturients reported minimal or moderate low-back pain throughout labor, while parturients in the control group reported an increased intensity of low-back pain as labor progressed. The effect of suprapubic pain was insignificant in both groups. Neither TNS nor nitrous oxide-oxygen mixture and pethidine could reduce this pain component. Course of labor, uterine activity and fetal heart patterns were similar in the two groups. The neonates were evaluated with Apgar score, assays of blood samples from the umbilical vein including blood lactate, plasma hypoxanthine and blood gas, and neurobehavioral assessment on two occasions. All newborn infants were in good condition and no significant differences between the two groups could be demonstrated.

Pain relief in labor by transcutaneous electrical nerve stimulation. A prospective matched study.

The study evaluated transcutaneous electrical nerve stimulation (TNS) for pain relief in labor, used in parallel with conventional methods. The investigation comprised 566 vaginally delivered women, 283 of whom were given TNS. Pain relief was evaluated with a questionnaire which the women answered shortly after delivery. With a statistical multivariate technique, it was concluded that TNS has a specific effect on pain localized to the back. Few women in either the TNS or the control group reported good relief of pain localized to the suprapubic region. Nitrous oxide-oxygen mixture was used less often in the TNS group than in the controls. Duration of labor and maternal blood loss were comparable in the two groups. The babies borne by primiparae in the TNS group tended to have better Apgar scores. Fewer babies of primiparae in the TNS group required observation for two days or more on the neonatal ward than was the case with the controls. However, the electrical stimulation could not be used optimally as it interfered with monitoring the fetal heart rate in half the cases. It is concluded that although TNS has a good effect on low-back pain and seems to have no negative effects on the mother or child, it is only a complement to conventional methods.