22 research outputs found
The influence of elastic orthotic belt on sagittal profile in adolescent idiopathic thoracic scoliosis: a comparative radiographic study with Milwaukee brace
<p>Abstract</p> <p>Background</p> <p>The effectiveness of bracing on preventing curve progression in coronal plane for mild and moderate adolescent idiopathic scoliosis (AIS) patients has been confirmed by previous radiographic researches. However, a hypokyphotic effect on the sagittal plane has been reported by a few studies. A relatively increasing number of AIS patients were noticed to wear a new kind of elastic orthotic belt for the treatments of scoliosis without doctors' instructions. We postulate the correcting mechanism of this new appliance may cause flattening of the spine. To our knowledge, no study has investigated the effects of this new orthosis on the sagittal profile of AIS patients. The aim of this study was to evaluate and compare the effects of elastic orthotic belt and Milwaukee brace on the sagittal alignment in AIS patients.</p> <p>Methods</p> <p>Twenty-eight female AIS patients with mild or moderate thoracic curves were included in this study. Standing full-length lateral radiographs were obtained in three conditions: natural standing posture without any treatment, with elastic orthotic belt and with Milwaukee brace. Thoracic kyphosis (TK), lumber lordosis (LL) and pelvic incidence (PI) were measured and compared between the above three conditions.</p> <p>Results</p> <p>Both elastic orthotic belt and Milwaukee brace can lead to significant decrease of TK, however, the decrease of TK after wearing elastic orthotic belt is significantly larger than that after wearing Milwaukee brace. Compared with no treatment, LL was found to be significantly smaller after wearing Milwaukee brace, however, such significant decrease was not noted after wearing elastic orthotic belt. No significant changes were observed for the PI between 3 conditions.</p> <p>Conclusions</p> <p>The elastic orthotic belt could lead to more severe thoracic hypokyphosis when compared with Milwaukee brace. This belt may not be a suitable conservative method for the treatment of mild and moderate AIS patients.</p
Risk factors for nosocomial bloodstream infections.
A retrospective study of 205 patients was performed to identify the risk factors associated with nosocomial bloodstream infection (BSI). The study occurred during a 5-month period in four medical-surgical intensive care units (ICUs) in Athens, Greece. Risk factors were determined using single and multivariate analyses. Thirty-five patients developed nosocomial BSI (17.1%). The incidence density (defined as the number of new cases of BSI divided by the total of patient-days in the population studied; Jarvis, 1997) of BSI was 14.3 per 1000 patient-days (total number of days that patients are in the ICU during the selected time period). A multivariate model showed that only three factors were significantly and independently responsible for nosocomial BSI: the length of ICU stay (adjusted odds ratios (AOR) 1.052, 95% confidence interval (CI) 1.018-1.087, P = 0.002); the presence of trauma at admission (AOR 2.622, 95% CI 1.074-6.404, P = 0.034); and nosocomial ventilator-associated pneumonia (AOR 6.153, 95% CI 2.305-16.422, P = 0.000). These results show that the factors that had most influence on the development of nosocomial BSI were those factors associated with the treatment received by patients during ICU stay
The immediate effect of a Boston brace on lung volumes and pulmonary compliance in mild adolescent idiopathic scoliosis
Idiopathic scoliosis (IS) is known to result in lung volume and
pulmonary compliance reduction. Boston brace treatment of IS is an
additional factor causing restrictive respiratory syndrome due to
external chest wall compression. Nevertheless, the immediate effect of
Boston bracing on the pulmonary compliance of scoliotic patients has not
been studied systematically. Spirometric and plethysmographic lung
volumes, static lung compliance (C-ST(L)) and specific lung compliance
(C-ST(L)/functional residual capacity) of 15 scoliotic adolescents (14
females and 1 male, of mean age 14. 1 +/- 1.67 years, with mean Cobb
angle 24.1 degrees +/- 7.88 degrees) were recorded twice, in a random
sequence: once without the Boston brace (nBB) and once immediately after
wearing the brace (BB). Our findings showed that bracing reduced vital
capacity, residual volume, functional residual capacity (FRC), total
lung capacity, and forced expiratory volume in 1 s in a proportional and
significant way (P < 0.001). C-ST(L) was also significantly reduced (P <
0.001), but C-ST(L)/FRC remained unaltered. All BE and nBB indices were
highly correlated. We concluded that Boston bracing in IS patients
results in an immediate, predictable, and uniform reduction of lung
volumes and pulmonary compliance. The reduction of C-ST(L), under
bracing conditions was I elated to the decrease of lung volume; the
C-ST(L)/FRC remained unaltered
Sepsis severity is the major determinant of circulating thrombopoietin levels in septic patients
Objective: To measure serum thrombopoietin levels and to investigate
their relationship with platelet counts and other potential determinants
in septic patients.
Design: Prospective study comparing septic patients and healthy
volunteers.
Setting: General intensive care units in two tertiary university
hospitals.
Patients: A total of 152 consecutive septic patients (69 with sepsis, 24
with severe sepsis, and 59 with septic shock). Twenty-two healthy
volunteers served as control subjects. Sepsis severity was determined by
grading septic patients in those having sepsis, severe sepsis, and
septic shock.
Interventions. None.
Measurements and Main Results. After blood sampling, platelet counts,
and serum thrombopoietin, interleukin-6 and C-reactive protein levels
were measured. Platelets did not decrease in patients with sepsis, but
they significantly decreased in patients with severe sepsis and septic
shock (p <.01 vs. controls and sepsis). In contrast, thrombopoietin
levels (median [range]) increased in patients with sepsis (159
[34-1272] pg/mL) compared with controls (57 [33-333] pg/mL, p
<.001), exhibiting further significant increase in patients with severe
sepsis and septic shock (461 [73-1550] and 522 [45-2313] pg/mL,
respectively, p <.001 vs. sepsis). In multiple regression analysis,
thrombopoietin levels were independently related only to sepsis severity
(higher in patients with increased sepsis severity, p <.001) and
platelet counts (higher in patients with lower platelet counts, p
=.004). Sepsis severity accounted for most of the variance explained by
the model. Thrombopoietin was significantly related to interleukin-6
(r(2) =.26) and C-reactive protein (r(2) =.37, p <.001 for both). In
serial measurements, interleukin-6 peak values constantly preceded those
of thrombopoietin, whereas peaks in thrombopoietin levels coincided with
clinical episodes of septic shock.
Conclusions: Sepsis severity is the major determinant of elevated
thrombopoiefin levels in septic patients, whereas platelet count is a
secondary determinant. Thrombopoietin represents a potential marker of
sepsis severity