Incidence and outcome of scoliosis in children with pleural infection.

AIMS: To ascertain the incidence and outcome of secondary scoliosis associated with parapneumonic effusions/empyema. METHODS: Retrospective review of case notes of children with pleural effusions over a 3-year period. Review of digitalized erect chest radiographs by two observers with serial measurements of Cobb angles. Scoliosis defined as lateral curvature of the spine > or = 10 degrees. RESULTS: Of 122 children (median age 4.3 years), 103 (84%) required chest drains of whom 83/103 (81%) received urokinase; 5 (4%) required surgical decortication. On admission, 56 (46%) had a scoliosis, 68 (62%) on the 2nd radiograph, and 68 (59%) at discharge; overall 87 (71%) had a scoliosis at some stage. In all cases, there was a single thoracic curve with the direction towards the side of the effusion. There was no association between scoliosis and size or type of effusion, nor inflammatory markers. There was a statistically significant but small effect from duration of illness prior to admission. At follow-up, 6 (5%) had a mild residual scoliosis but all subsequently resolved. Intraobserver variability for measurement of Cobb angles was +/-4.6 degrees and interobserver variability was +/-5.8 degrees. CONCLUSIONS: Scoliosis was common but always resolved so therapy is unnecessary; follow up is recommended to exclude coincidental idiopathic scoliosis.

A 48-week, randomized, open-label comparison of three abacavir-based substitution approaches in the management of dyslipidemia and peripheral lipoatrophy.

BACKGROUND: The mechanisms by which dyslipidemia and lipoatrophy develop during antiretroviral therapy are not clear. No treatment of lipoatrophy is currently established. METHODS: This was an open-label randomized study of HIV-positive individuals on a first-line therapy containing stavudine (d4T) with either a protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI) and with hypercholesterolemia (defined as total cholesterol >5.2 mmol/L or >180 mg/dL) and/or lipoatrophy and with a viral load of <50 copies/mL. Patients switched d4T to abacavir (ABC) (group 1), a PI or NNRTI to ABC (group 2), or d4T and PI or NNRTI to ABC plus AZT (group 3). Patients were followed-up with fasting blood levels, dual-energy X-ray absorptiometry (DXA), and computed tomography (CT) scans for 48 weeks. RESULTS: Thirty patients were included, with 27 completing 48 weeks of therapy. One ABC hypersensitivity reaction was the only serious adverse event. All patients' viral loads remained at <50 copies/mL. CD4 cell counts rose in groups 2 and 3 but fell modestly in group 1. Total and low-density lipoprotein cholesterol improved significantly in groups 2 and 3. Triglycerides fell significantly in group 2. In contrast, total, arm, and leg fat mass (by DXA) rose significantly in group 1 but fell modestly in groups 2 and 3. Visceral adiposity (by CT scan) was unaffected in all groups. CONCLUSIONS: Abacavir represents a virologically effective replacement for d4T, PI, or NNRTI in persons on successful first-line therapy. Replacement of a PI or NNRTI with ABC leads to modest improvement in both cholesterol and triglycerides. Replacement of d4T with ABC leads to modest improvements in fat mass.

Aortic compliance in young patients with heterozygous familial hypercholesterolaemia.

1. Aortic compliance and plasma lipid and lipoprotein levels were measured in 20 young patients with heterozygous familial hypercholesterolaemia and in 20 age- and sex-matched control subjects. 2. Patients with familial hypercholesterolaemia had significantly higher plasma cholesterol, low-density lipoprotein-cholesterol and triacylglycerol levels than control subjects (P < 0.001, P < 0.001 and P < 0.005, respectively). The patients with familial hypercholesterolemia also had significantly more compliant (distensible) aortas than the control subjects (P < 0.001), a significant inverse correlation being observed between compliance and age (r = 0.73, P < 0.001) and between compliance and mean blood pressure (r = -0.60, P < 0.005). 3. When the effects of age and sex on aortic compliance were corrected for, the blood pressure effect disappeared, significant correlations being observed between normalized compliance and cholesterol (r = 0.50, P < 0.03), low-density lipoprotein-cholesterol (r = 0.54, P < 0.01), high-density lipoprotein-cholesterol (r = -0.44, P < 0.05), low-density lipoprotein-/high-density lipoprotein-cholesterol ratio (r = 0.60, P < 0.0006) and duration of disease (r = 0.67, P < 0.002). Multivariate regression analysis showed that the low-density lipoprotein-/high-density lipoprotein-cholesterol ratio (P < 0.03) and duration of disease (P < 0.04) were the best predictors of normalized compliance. 4. We suggest that the measurement of aortic compliance in young patients with familial hypercholesterolaemia may potentially be a useful, non-invasive, research tool for assessing their susceptibility to atheroma.

Non-invasive Doppler ultrasound technique for the in vivo assessment of aortic compliance.

A non-invasive Doppler ultrasound technique for the assessment of aortic compliance is described. This is based on the in vivo measurement of pulse wave velocity along the thoraco-abdominal aortic pathway. A structured protocol has been developed to improve the reproducibility of the technique as well as for the purposes of operator training. Preliminary results of a study of both the intra- and inter-observer variability of the method are provided and problems associated with the technique are discussed. Medical disorders such as atherosclerosis, diabetes mellitus and familial hypercholesterolaemia have all been shown to affect arterial wall compliance. We suggest that the measurement of aortic compliance in vivo may be a useful, non-invasive tool for assessing these patients' susceptibility to atheromatous arterial disease and for monitoring their response to therapy.