Health-Related Predictive Factors of Brazilian Children With Early Onset Scoliosis Using the EOSQ-24 and CHQ-PF50 Questionnaires.

BACKGROUND: Assessing the quality of life (QOL) of children with early onset scoliosis (EOS) has been discussed recently. Therefore, the study aimed to apply and correlate the 24-item Early Onset Scoliosis Questionnaire (EOSQ-24) with the 50-item Childhood Health Questionnaire (CHQ-PF50) to find predictive factors impacting QOL. METHODS: Cross-sectional study involving a population of caregivers of patients with EOS. The sample consisted of 72 patients. Two research assistants applied the Portuguese version of the EOSQ-24 and CHQ-PF50 in 3 treatment centers. The EOSQ-24 assesses the subjective response of children with EOS from the parent's point of view. The CHQ is a self-administered questionnaire or parental proxy assessment of the psychological and social status of children aged 5 to 18 years. RESULTS: Of 72 patients, 41 (56.9%) were females, mean age of 11.9 ± 4.2 years. The most common scoliosis was of neuromuscular origin (32%). The CHQ-PF50 showed that family-related items had significant scores. The most affected subcategory was physical function (45.5), and the least affected was mental health (90.8). Thus, the CHQ-PF50 PhS summary index was 27, and the CHQ-PF50 PsS was 71.7. Moreover, the critical categories for the EOSQ-24 questionnaire were daily life and physical function (45.1 and 47.8, respectively), and the least affected categories were transfer and pulmonary function (70.8 and 68.9, respectively). Four subcategories showed a strong correlation between both questionnaires: general health (r = 0.749, P < 0.001), physical function (r = 0.645, P < 0.001), bodily pain (r = 0.714, P < 0.001), and mental health (r = 0.424, P < 0.001). Using CHQ-PF50 as a dependent variable in multiple regression analysis (P = 0.028), the only variable affecting the scores was syndromic scoliosis (P = 0.019; 95% CI -27.4 to -2.5). CONCLUSION: A strong correlation between both questionnaires was seen for general health, physical function, bodily pain, and mental health. Syndromic scoliosis was a predictor of worse QOL according to the CHQ-PF50.

Incidence of complications in the management of non-ambulatory neuromuscular early-onset scoliosis with a rib-based growing system: high- versus low-tone patients.

PURPOSE: The purpose of this study is to evaluate whether patients with high-tone neuromuscular early-onset scoliosis have different surgical outcome and complication rate, when compared to patients with low-tone neuromuscular early-onset scoliosis treated with a rib-to-pelvis rib-based dual growing system. METHODS: This is a retrospective cohort study of 67 neuromuscular early-onset scoliosis patients, collected from a multicenter database, treated with a rib-to-pelvis rib-based dual growing system. All patients were divided into two groups: high tone and low tone. Pre-, intra- and postoperative data were compared between both groups. Complications were reported by a standardized system. RESULTS: Twenty-six high-tone and 41 low-tone patients were found homogeneous regarding gender, age at surgery, weight, height, estimated blood loss and surgery time. High-tone group (19/26 = 73.1%) experiences more postoperative complications than low-tone group (22/41 = 53.7%). Most common complications were infection, device migration, death and hardware failure. Permanent abandonment of rib-based growing technique and device removal was required in 21% of high-tone patients (P < 0.001). None of the low-tone patients required abandonment. CONCLUSION: High-tone patients had more complications than those with low tone in management of neuromuscular early-onset scoliosis treated with a rib-to-pelvis rib-based dual growing system. A different surgical approach may be required to treat the high-tone neuromuscular early-onset scoliosis.

VEPTR Implantation to Treat Children With Early-Onset Scoliosis Without Rib Abnormalities: Early Results From a Prospective Multicenter Study.

BACKGROUND: Thoracoplasty and insertion of vertical expandable prosthetic titanium rib (VEPTR) for thoracic and spine distraction has been found to be effective in the treatment of early-onset scoliosis (EOS) with ribs anomalies and congenital vertebral anomalies. The aim of this study was to evaluate the efficacy of VEPTR in preventing further progression of scoliosis without impeding spinal growth in children with progressive EOS without rib abnormalities. METHODS: This is a prospective, multicenter, observational cohort study. Erect radiographs were analyzed for coronal and sagittal curve and height measurements at preimplant, immediate postoperative, and at 2-year follow-up. RESULTS: Sixty-three patients met inclusion: 35 males and 28 females. Mean age at time of implantation was 6.1±2.4 years. Etiologies included congenital (n=6), neuromuscular (n=36), syndromic (n=4), and idiopathic (n=17). The mean follow-up was 2.2±0.4 years. Scoliosis (72±18 degrees) decreased after implant surgery (47±17 degrees) followed by slight increase at 2-year follow-up (57±18 degrees), P<0.0001. Kyphosis (48±22 degrees) also showed significant decrease after implantation (40±14 degrees), but increased after 2 years (48±16 degrees), P<0.0001. Coronal spine height measurements including T1-T12 (15.7±3 cm) and T1-S1 (25±6 cm) showed significant increases after implantation surgery (17.7±4 cm and 28.6±6 cm, respectively) and at 2 years (18.4±4 cm and 29.1±5 cm, respectively), P<0.0001. The increase in coronal spine height represented 144% of expected age-matched T1-T12 growth and 193% of expected age-matched T1-S1 growth. Similarly, sagittal spine length of T1-T12 and T1-S1 increased from 16.9±2.7 cm and 27.1±3.9 cm, respectively preoperatively to 19.7±3.5 cm and 31.9±5.1 cm, respectively at 2-year follow-up, P<0.0001. The instrumented spine segment continued growth from 25.8±5.2 cm after implantation to 27.4±5.3 cm at 2-year follow-up, P<0.0001. Thirty-one patients (49%) had at least 1 complication with total of 58 complications. CONCLUSIONS: At 2-year follow-up, VEPTR was effective in treating EOS without rib abnormalities with 86% of patients having an improvement in scoliosis and 94% of patients having an increased spinal height as compared with preoperative values. This study proved that spine continues to grow after VEPTR instrumentation during the distraction phase. This amount of growth represents about 40% for T1-T12 and 31% for T1-S1 spine of the expected age-matched growth based on Dimeglio reference numbers. We find this growth important as it proves continuous spine growth with VEPTR treatment. LEVEL OF EVIDENCE: Level II.

Quality, Safety, and Value in Pediatric Orthopaedic Surgery.

Enhancing patient safety and the quality of care continues to be a focus of considerable public and professional interest. We have made dramatic strides in our technical ability to care for children with pediatric orthopaedic problems, but it has become increasingly obvious that there are also significant opportunities to improve the quality, safety, and value of the care we deliver. The purpose of this article is to introduce pediatric orthopaedic surgeons to the rationale for and principles of quality improvement and to provide an update on quality, safety, and value projects within Pediatric Orthopaedic Society of North America.

El retrato de una lesión de la vía biliar / Portrait of a Bile Duct Injury

El contacto entre la cirugía y la tecnología tuvo su cúspide a finales del siglo XX con el advenimiento de la cirugía laparoscópica. En 1989 Jacques Perissat presentó su técnica de colecistectomía laparoscópica a la Sociedad Americana de Cirujanos Endoscópicos y Gastrointestinales (SAGES), en Louisville Kentucky. Este evento fue el punto de partida que posteriormente siguió el futuro de la cirugía mínimamente invasiva a nivel mundial. El objetivo de éste artículo, es mostrar los distintos escenarios en los que durante una colecistectomía laparoscópica incluso el cirujano más hábil puede verse inmerso: la identificación de una lesión de la vía biliar.

With the advent of laparoscopic surgery toward the end of the 20th Century, the merging of surgery and technology attained new heights. In 1989 JaquesPerissant presented his technique for laparoscopic cholecystectomy at the meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in Louisville , Kentucky. This was the starting point for what was to become in the future the worldwide use of minimally invasive surgery. The aim of this article is to describe those scenarios which, even in the ablest hands, can lead to a bile duct injury during laparoscopic cholecystectomy.

Como Cirujanos ¿Qué sabemos de publicar? / As surgeons, What do we know about publishing

La publicación de un artículo científico es la culminación de todo trabajo de investigación. Las guías internacionales de publicación determinan las normas actuales para autores de manuscritos. El objetivo de este trabajo era determinar el grado de conocimiento de los conceptos de publicación sobre revisión por pares, autoría, conflicto de intereses y publicación secundaria aceptable de los cirujanos graduados y de los residentes de cirugía...

Surgeon practices regarding infection prevention for pediatric spinal surgery.

BACKGROUND: A postoperative spinal infection has significant financial and emotional impact on the patient, family, and health care system. The purpose of this study is to understand approaches used by pediatric spinal surgeons with regard to infection prevention. METHODS: A survey was electronically distributed to 277 POSNA/SRS members. A total of 123 responses were obtained (44%). Eighty-one percent of participating surgeons were in academic practices. Among responders, 82% have been in practice for >10 years, and only 5% have been in practice <5 years. RESULTS: Sixty-four percent of surgeons responded that they knew their infection rate over the last year, and average reported rates were 1.3% and 5.3% in idiopathic and neuromuscular patients, respectively. The surgeon estimated rates were 0.5% and 4.4% in similar populations for those who did not exactly know their infection rates. Preoperatively, 50% of surgeons suggest chlrorhexidine use at home. Preoperative labs to stratify risk are obtained in 54% of neuromuscular patients and 9% of all patients. MRSA swabs and urine cultures are used variably preoperatively. IV antibiotic use before incision commonly includes not only cephalosporins (>80%), but also frequently involves vancomycin. Forty-seven percent of neuromuscular patients receive gram-negative coverage, whereas only 11% of idiopathic patients do. Skin preparation methods are highly variable among responding physicians. Vancomycin powder is used with the bone graft in 24% of all patients, with gentamycin and vancomycin used variably in idiopathic and neuromuscular patients. Policies limiting scrub wear out of the hospital and traffic in the operating room, the use of UV lights or negative pressure ventilation, and use of drains were also variable. CONCLUSION: There is significant variability in the current practices of surgeons who perform spinal deformity surgery with regard to infection prevention. Such variability most likely results from a lack of good evidence and may reflect suboptimal care. This data can be used as a starting point to help design and direct multicenter studies with an ultimate goal of reducing infection after spinal deformity surgery. LEVEL OF EVIDENCE: Level V.

Psychological dysfunction in children who require repetitive surgery for early onset scoliosis.

BACKGROUND: Little is known regarding the psychological dysfunction in children who require repetitive surgery for early onset scoliosis (EOS). This study was conducted to examine the neurobehavioral functioning of children with EOS at various stages of treatment with the rib-based growing rod system (RBGRS). We hypothesized that these children would demonstrate evidence of neurobehavioral dysfunction. METHODS: Twelve patients were included in the analyses. At the time of the evaluation, baseline clinical, and demographic information and the number of RBGRS-related surgeries were obtained. All patients were evaluated with semistuctured interviews by a pediatric clinical psychologist using the Behavior Assessment System for Children--2nd Edition-Spanish Version (BASC-2) psychological tool between 1.5 to 3 years from the initial RBGRS implantations. RESULTS: Of the 12 patients under investigation, 25% scored in a clinically significant range on at least 1 scale, 33% scored in an at-risk range on at least 1 scale, and 42% had normal range for all scales in the BASC-2 measurement. Patients who scored in a clinically significant range in at least 1 of the scales in the BASC-2 measurement were younger at initial RBGS implantation. They had more total surgeries and RBGRS surgeries than patients who did not score in the range. CONCLUSIONS: Clinicians caring for children with EOS should have a heightened awareness for possible adverse psychological outcomes in this population and consider early referral for appropriate psychological assessment and care. Additional studies are necessary to further qualify and quantify the psychological effects of multiple anesthesia surgeries in EOS patients. LEVEL OF EVIDENCE: Level III.

Estudio comparativo entre ligadura con banda elástica y escleroterapia en el tratamiento de hemorroides internas / Comparative study between rubber band ligation and sclerotherapy in the treatment of internal haemorroids

Introducción: La enfermedad hemorroidal interna es la patología ano-rectal más común. Entre los tratamientos más utilizados están la ligadura con banda elástica y la escleroterapia, este estudio se efectuó con el fin de comparar efectividad y prevalencia de complicaciones entre ambos procedimientos. Metodología: Se seleccionarion 60 pacientes mayores de 12 años de edad, de cualquier sexo con hemorroides internas grado I sintomáticas, II y III, dividiéndolos en 2 grupos de 30 pacientes cada uno. Al grupo uno se le dió tratamiento con escleroterapia con fenol al 5 por ciento en aceite de oliva, y al grupo dos ligadura con banda elástica, además de reconmendarles una dieta alta en fibra. Resultados: Se evaluó por cuestionario el sangrado rectal, prolapso hemorroidal, dolor al defecar, prurito y descarga anal, y se efectuó evaluación por anoscopía para estadificar hemorroides. El 6.7 por ciento de pacientes ligados y 3.3 por ciento de pacientes esclerosados presentaron reflejo vagovagal inmediato al tratamiento y los pacientes ligados presentaron más tenesmo que los esclerosados (p'0.05). A los 30 días se repitió el cuestionario y la anoscopía clasificando la evaluación médica con el criterio del paciente en base a efectividad así: Curado, mejorado, sigue igual y está peor. La efectividad encontrada fue del 96.7 por ciento para los pacientes tratados con ligadura y 93.3 por ciento para los esclerosados (p>0.05); teniendo que repetir el tratamiento a uno y dos pacientes respectivamente. Conclusiones: No existe diferencia entre efectividad y complicaciones entre ambos procedimientos