Does Implant Density Impact Three-Dimensional Deformity Correction in Adolescent Idiopathic Scoliosis with Lenke 1 and 2 Curves Treated by Posterior Spinal Fusion without Ponte Osteotomies?

Methods@#A database of patients with AIS with Lenke 1 and 2 curves treated with PSF without PO and instrumented with PSs and ≥2-year follow-up was reviewed. The preoperative, immediate, and final follow-up postoperative radiographs were analyzed. The correlation between PS density and the following factors were determined: major curve correction (MCC), correction index (CI; MCC/curve flexibility), kyphosis angle change, and rib index (RI) correction. Then, patients were divided into low-density (LD) and high-density (HD) groups according to mean PS density for the entire cohort (1.5 PS per level). Demographics and radiographic and clinical outcomes were compared between groups. @*Results@#The study included 99 patients with Lenke 1 and 23 patients with Lenke 2 AIS. The average MCC was 67.2%. There was no correlation between screw density and these parameters: MCC (r=0.10, p=0.26), CI (r=0.16, p=0.07), change in T2–T12 kyphosis angle (r=−0.13, p=0.14), and RI correction (r=−0.09, p=0.37). Demographic and preoperative radiographic parameters were similar between the LD and HD groups. At the latest follow-up, there were no differences between the two groups in regard to MCC, CI, change in T2–T12 kyphosis angle, RI correction, and Scoliosis Research Society-30 scores (all p>0.05). @*Conclusions@#This study revealed no significant correlation between screw density and curve correction in any planes. HD construct may not provide better deformity correction in patients with flexible and moderate thoracic AIS undergoing PSF without PO.

rare case of situs inversus with dextrocardia, Lutembacher syndrome, and pericardial effusion

Incidence of congenital cardiac anomalies in dextrocardia with situs inversus is low as compared to congenital cardiac anomalies in isolated dextrocardia. We describe the first ever case of situs inversus with dextrocardia, Lutembacher's syndrome, and pericardial effusion. The pericardial effusion in our case was acquired and was tubercular in etiology

Pheochromocytoma - an institutional experience

The present study envisages evaluating the clinical presentation, diagnosis, management, with particular reference to pharmacological and anesthetic considerations, and outcome in patients with pheochromocytoma. A retrospective study. The study was conducted at the Department of Surgery, Kasturba Medical College Hospital, Manipal, India from January 1, 1996 to December 31, 2003. Seventeen patients diagnosed to have pheochromocytoma were included for this study. Our assessment of age at presentation, sex, presenting complaints with details of hypertension [HT], diagnostic tests, surgical procedure and follow-up was based on patient records. Peak incidence was observed in 40-50 years age group, with male preponderance. All the patients had diastolic HT of more than 100 mm of Hg at presentation. Systolic blood pressures [SBP] were between 150 mm Hg to 230 mm Hg, with mean of 170 mm Hg; nine patients presented with persistent HT and seven had paroxysmal HT. One patient infact presented with hypotension due to septic shock and was incidentally detected to have an adrenal tumor. Computed tomography [CT] scan and urinary levels of vanillylmandelic acid [VMA] were mainstay of diagnosis. These patients had adequate preoperative control of HT. All patients underwent exploration of the tumor by an extraperitoneal approach. 70% tumors were on the right and 30% were on the left side. Histopathologically, all the tumors were benign except for one, which was malignant. An average of three to five units of blood transfusion was required and mean operating time was 4.5 hours. Six patients had extensive intra-operative blood pressure [BP] fluctuation, but were adequately managed by the anesthetic team. One patient with post-operative pulmonary edema died in our series; rest all the patients are on regular follow-up, till date and doing well. Pheochromocytoma is an important cause of endocrine HT. Elevated urinary VMA is diagnostic of this tumor with imaging studies used to localize the tumor. Adrenalectomy results in complete cure of HT with an excellent long-term outcome