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Benny Dahl - One of the best experts on this subject based on the ideXlab platform.
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increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
Pediatrics, 2020Co-Authors: Lorenzo Deveza, John Heydemann, Frank Gerow, William A Phillips, Darrell Hanson, Benny DahlAbstract:Purpose: Non-idiopathic Scoliosis encompasses a group of diagnoses including neuromuscular, syndromic, and congenital Scoliosis. Neuromuscular Scoliosis includes conditions such as cerebral palsy, muscular dystrophy, and spinal muscular atrophy. Syndromic Scoliosis patients are those with Marfan’s Syndrome, Down Syndrome, and DiGeorge Syndrome. Congenital Scoliosis are patients with a congenitally malformed vertebra. It is known that those with neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic …
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p89 increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
The Spine Journal, 2019Co-Authors: Lorenzo Deveza, John Heydemann, Benny DahlAbstract:BACKGROUND CONTEXT Non-idiopathic Scoliosis encompasses a group of diagnoses including neuromuscular, syndromic and congenital Scoliosis. It is known that those with neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic or congenital Scoliosis do not share the same characteristics and are often treated similarly to those with neuromuscular Scoliosis. The clinical differences between pediatric patients with neuromuscular Scoliosis and syndromic/congenital Scoliosis are not well described. PURPOSE To assess differences in pediatric non-idiopathic Scoliosis patients with neuromuscular Scoliosis (NM) vs syndromic and congenital Scoliosis (SS/CS). STUDY DESIGN/SETTING Retrospective cohort study at a single pediatric institution analyzing all cases involving spinal instrumentation for non-idiopathic Scoliosis comparing NM and SS/CS patients. PATIENT SAMPLE All pediatric patients undergoing spinal instrumentation (n=251) for non-idiopathic Scoliosis at a single institution from 2012-2016. OUTCOME MEASURES Intraoperative estimated blood loss by patient weight (ml/kg); Postoperative blood transfusion (ml); mortality at 30 days and 1 year; surgical site infections (SSI); revision surgery and instrument failure in 1 year; readmission in 30 days; return to OR and emergency room visits in 90 days. METHODS This is a retrospective review of all pediatric patients undergoing spinal instrumentation for non-idiopathic Scoliosis. Neuromuscular Scoliosis (NM) patients (n=112 patients, 128 cases) were compared against syndromic and congenital Scoliosis (SS/CS) patients (n=62 patients, 69 cases). Demographics, patient characteristics and outcomes were compared. Variables were analyzed by students' t-test and Categorical variables were analyzed by Chi-Square Test. RESULTS NM patients were older than those with SS/CS (13.3±3.5 NM vs 11.7±3.5 SS/CS, p=0.002). There were no differences in gender and BMI. In terms of pre-existing conditions, there was a higher percentage of NM patients with pulmonary disease (61.2% NM vs 24.3% SS/CS, p CONCLUSIONS Non-idiopathic patients with NM Scoliosis have different patient characteristics and subsequent postoperative complications than those with SS and CS. NM patients are more likely to have pulmonary disease and seizures. Intra-operatively, NM patients have more blood loss. Postoperatively, NM patients have more complications including SSI, readmission and return to OR at 90 days. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Keith M Bagnall - One of the best experts on this subject based on the ideXlab platform.
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pineal transplantation after pinealectomy in young chickens has no effect on the development of Scoliosis
Spine, 2001Co-Authors: Keith M Bagnall, James V Raso, M Beuerlein, J Wilson, Paul Johnson, Marc MoreauAbstract:Study Design. Three experimental groups and one control group of chickens underwent different surgical procedures to determine the effects of pineal gland transplantation on the development of Scoliosis. Objective. To determine whether transplantation of the pineal gland to the body wall musculature maintains serum melatonin levels at normal values and prevents the development of Scoliosis. Summary of Background Data. Scoliosis occurs consistently after pinealectomy in young chickens. Many characteristics of this Scoliosis are similar to those seen in patients with adolescent idiopathic Scoliosis. It is not clear whether the underlying mechanism is dependent on reduced levels of serum melatonin or some other aspect of the extensive surgery. Methods. Four groups of chickens were selected: normal chickens, pinealectomized chickens, chickens that underwent simple cutting of the pineal stalk, and chickens that underwent transplantation of the pineal gland into the body wall. Development of Scoliosis was determined from measurement of the Cobb angle from weekly radiographs. Results. All of the experimental groups showed the same levels of incidence and the same patterns of Scoliosis development. Serum melatonin levels were reduced to nearly zero in all the experimental groups for the duration of the experiment. Scoliosis developed in none of the normal chickens. Conclusions. Neither transplantation of the pineal gland into the body wall musculature nor simple cutting of the pineal stalk was able to maintain normal levels of serum melatonin because both procedures reduced levels to nearly zero. The incidence and pattern of Scoliosis development in these groups were the same as those for the pinealectomized group. Reduction of serum melatonin levels remains a prerequisite for Scoliosis development in young chickens.
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the critical stage of pinealectomy surgery after which Scoliosis is produced in young chickens
Spine, 2001Co-Authors: M Beuerlein, Xiaoping Wang, Marc Moreau, V J Raso, J Mahood, J Wilson, B J Greenhill, Keith M BagnallAbstract:Study design Stages of the surgical procedure for pinealectomy in chickens were identified. Groups of chickens were selected for each stage. Scoliosis development was identified from radiographs. Objectives To determine the critical stage of surgery for pinealectomy after which Scoliosis develops in young chickens. Summary of background data Pinealectomy in young chickens consistently produces Scoliosis in young chickens that has many characteristics similar to those seen in patients with adolescent idiopathic Scoliosis. The mechanism behind this phenomenon remains unknown. Methods Five distinct stages in the pinealectomy surgery were identified. Groups of chickens were selected to undergo surgery to represent these five stages. Scoliosis was determined from weekly radiographs. Results Cutting the pineal stalk was identified as the critical stage in the surgery after which Scoliosis developed. The incidence of Scoliosis did not increase after more extensive surgery in which the pineal bulb was removed from the skull. This stage was also correlated with a significant reduction of serum melatonin levels. Conclusions Cutting the pineal stalk was identified as the critical stage of pinealectomy surgery after which Scoliosis may develop. This stage was also correlated with the significant reduction of average serum melatonin levels. These results allow the focus of attention into the mechanism behind this phenomenon to center on the consequences of cutting the pineal stalk rather than total removal of the pineal gland.
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the effects of melatonin therapy on the development of Scoliosis after pinealectomy in the chicken
Journal of Bone and Joint Surgery American Volume, 1999Co-Authors: Keith M Bagnall, Xiaoping Wang, Marc Moreau, J Mahood, James V Raso, Jie ZhaoAbstract:The mechanism underlying the development of Scoliosis after pinealectomy in young chickens is unknown. However, since the main product of the pineal gland is melatonin, melatonin remains an obvious focus in studies designed to discover this mechanism. One confounding factor is that serum melatonin levels are close to zero after pinealectomy but Scoliosis does not develop in all chickens that have had this procedure. Therefore, the role of melatonin in the development of Scoliosis in chickens after pinealectomy remains controversial. In the current investigation, two pilot studies demonstrated that a physiological therapeutic dose of melatonin (2.5 milligrams per kilogram of body weight) restored the circadian rhythm of melatonin, as measured by serum assay. In the main study, this dose was administered daily starting either immediately after the pinealectomy or two weeks after it, when Scoliosis had developed. Scoliosis was assessed on weekly radiographs, and the Cobb angle was determined for all chickens in which Scoliosis developed. Overall, Scoliosis developed in only 56 percent (fifty) of the eighty-nine chickens that had had a pinealectomy; this rate was consistent throughout all experimental groups. Scoliosis did not develop in any of the control chickens, which did not have a pinealectomy. On the basis of the average Cobb angles in the chickens in which Scoliosis had developed, it was determined that neither the prevalence nor the pattern of the Scoliosis was affected by the therapy in any of the experimental groups. It was thus concluded that melatonin therapy after pinealectomy in young chickens has no effect on the development or progression of Scoliosis. These results raise doubts regarding the role of melatonin in the development of Scoliosis after pinealectomy in the young chicken. CLINICAL RELEVANCE: Although Scoliosis has been produced in some animal studies, none of these models has proved to be entirely satisfactory. Consequently, research regarding adolescent idiopathic Scoliosis has been hampered. Recently, it was shown that Scoliosis with many characteristics similar to those seen in patients who have adolescent idiopathic Scoliosis can be produced consistently in chickens after pinealectomy. This finding encourages the development of this model. An understanding of the mechanism involved in the development of Scoliosis after pinealectomy in chickens might provide new insights into adolescent idiopathic Scoliosis and aid in the development of novel treatment methods.
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the production of Scoliosis after pinealectomy in young chickens rats and hamsters
Spine, 1999Co-Authors: Cian Okelly, Xiaoping Wang, Marc Moreau, Jie Zhao, J Mahood, James Raso, Keith M BagnallAbstract:Study Design. This study involved weekly radiographic examination of pinealectomized rats, hamsters, and chickens to observe the development of Scoliosis. Objectives. To determine whether pinealectomy produces Scoliosis in animals more closely related phylogenetically to humans than to chickens, namely rats and hamsters, which are representative of mammals. Summary of Background Data. Pinealectomy in 3-day-old chickens has consistently resulted in the development of Scoliosis with many characteristics similar to those seen in patients with adolescent idiopathic Scoliosis. It has not been determined whether this phenomenon is restricted solely to chickens or is applicable to other animals, especially those more closely related to humans. Methods. The pineal gland was removed from young rats, hamsters, and chickens. All animals underwent radiography weekly to detect the development of any Scoliosis. Weight and length measurements were also taken weekly, and serum melatonin levels were determined at the time the animals were killed. Results. Scoliosis was not observed in either the rats or the hamsters. In contrast, Scoliosis developed in 10 of 21 chickens. Serum melatonin levels in all pinealectomized animals were zero. Conclusions. In contrast to the chickens, pinealectomy does not seem to cause Scoliosis in either young rats or hamsters. The reasons for this discrepancy may include differences in the physiology and spinal morphology of the rat and hamster in comparison with the chicken. In the pinealectomized chickens, the results also suggest that future Scoliosis development might be indicated by a significant increase in size when they are compared with pinealectomized chickens that do not develop Scoliosis. Such differences in growth rates also distinguish patients with adolescent idiopathic Scoliosis.
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changes in serum melatonin levels in response to pinealectomy in the chicken and its correlation with development of Scoliosis
Spine, 1998Co-Authors: Xiaoping Wang, Marc Moreau, V J Raso, Jie Zhao, Hongxing Jiang, J Mahood, Keith M BagnallAbstract:Study Design. Normal, sham, and groups of chickens subjected to pinealectomy from which serum melatonin levels were measured and correlated with Scoliosis development in a period of 5 weeks. Objectives. To measure serum melatonin levels in chickens subjected to pinealectomy and control chickens and correlate findings with development of Scoliosis. of Background Data. In a previous study by others, Scoliosis developed in 100% of chickens subjected to pinealectomy, and serum melatonin levels were found to be reduced. Previous results in a study by the authors showed Scoliosis developing in only approximately 55% of chickens that underwent pinealectomy. Methods. Young chickens were subjected to pinealectomy. Control groups consisted of sham operation and normal groups. Radiographs and blood samples were taken at weekly intervals to monitor Scoliosis development and measure serum melatonin levels using radioimmunoassay techniques. Results. Scoliosis developed in only 52% of chickens that underwent pinealectomy, but all had low levels of serum melatonin and no circadian rhythm. The chickens in the two control groups maintained normal serum melatonin levels and rhythms. Conclusions. Pinealectomy in young chickens reduces serum melatonin levels and eliminates the melatonin circadian rhythm. It can also produce Scoliosis, but low levels of serum melatonin are a poor predictor of development of Scoliosis.
Lorenzo Deveza - One of the best experts on this subject based on the ideXlab platform.
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increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
Pediatrics, 2020Co-Authors: Lorenzo Deveza, John Heydemann, Frank Gerow, William A Phillips, Darrell Hanson, Benny DahlAbstract:Purpose: Non-idiopathic Scoliosis encompasses a group of diagnoses including neuromuscular, syndromic, and congenital Scoliosis. Neuromuscular Scoliosis includes conditions such as cerebral palsy, muscular dystrophy, and spinal muscular atrophy. Syndromic Scoliosis patients are those with Marfan’s Syndrome, Down Syndrome, and DiGeorge Syndrome. Congenital Scoliosis are patients with a congenitally malformed vertebra. It is known that those with neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic …
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p89 increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
The Spine Journal, 2019Co-Authors: Lorenzo Deveza, John Heydemann, Benny DahlAbstract:BACKGROUND CONTEXT Non-idiopathic Scoliosis encompasses a group of diagnoses including neuromuscular, syndromic and congenital Scoliosis. It is known that those with neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic or congenital Scoliosis do not share the same characteristics and are often treated similarly to those with neuromuscular Scoliosis. The clinical differences between pediatric patients with neuromuscular Scoliosis and syndromic/congenital Scoliosis are not well described. PURPOSE To assess differences in pediatric non-idiopathic Scoliosis patients with neuromuscular Scoliosis (NM) vs syndromic and congenital Scoliosis (SS/CS). STUDY DESIGN/SETTING Retrospective cohort study at a single pediatric institution analyzing all cases involving spinal instrumentation for non-idiopathic Scoliosis comparing NM and SS/CS patients. PATIENT SAMPLE All pediatric patients undergoing spinal instrumentation (n=251) for non-idiopathic Scoliosis at a single institution from 2012-2016. OUTCOME MEASURES Intraoperative estimated blood loss by patient weight (ml/kg); Postoperative blood transfusion (ml); mortality at 30 days and 1 year; surgical site infections (SSI); revision surgery and instrument failure in 1 year; readmission in 30 days; return to OR and emergency room visits in 90 days. METHODS This is a retrospective review of all pediatric patients undergoing spinal instrumentation for non-idiopathic Scoliosis. Neuromuscular Scoliosis (NM) patients (n=112 patients, 128 cases) were compared against syndromic and congenital Scoliosis (SS/CS) patients (n=62 patients, 69 cases). Demographics, patient characteristics and outcomes were compared. Variables were analyzed by students' t-test and Categorical variables were analyzed by Chi-Square Test. RESULTS NM patients were older than those with SS/CS (13.3±3.5 NM vs 11.7±3.5 SS/CS, p=0.002). There were no differences in gender and BMI. In terms of pre-existing conditions, there was a higher percentage of NM patients with pulmonary disease (61.2% NM vs 24.3% SS/CS, p CONCLUSIONS Non-idiopathic patients with NM Scoliosis have different patient characteristics and subsequent postoperative complications than those with SS and CS. NM patients are more likely to have pulmonary disease and seizures. Intra-operatively, NM patients have more blood loss. Postoperatively, NM patients have more complications including SSI, readmission and return to OR at 90 days. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
Marc Moreau - One of the best experts on this subject based on the ideXlab platform.
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pineal transplantation after pinealectomy in young chickens has no effect on the development of Scoliosis
Spine, 2001Co-Authors: Keith M Bagnall, James V Raso, M Beuerlein, J Wilson, Paul Johnson, Marc MoreauAbstract:Study Design. Three experimental groups and one control group of chickens underwent different surgical procedures to determine the effects of pineal gland transplantation on the development of Scoliosis. Objective. To determine whether transplantation of the pineal gland to the body wall musculature maintains serum melatonin levels at normal values and prevents the development of Scoliosis. Summary of Background Data. Scoliosis occurs consistently after pinealectomy in young chickens. Many characteristics of this Scoliosis are similar to those seen in patients with adolescent idiopathic Scoliosis. It is not clear whether the underlying mechanism is dependent on reduced levels of serum melatonin or some other aspect of the extensive surgery. Methods. Four groups of chickens were selected: normal chickens, pinealectomized chickens, chickens that underwent simple cutting of the pineal stalk, and chickens that underwent transplantation of the pineal gland into the body wall. Development of Scoliosis was determined from measurement of the Cobb angle from weekly radiographs. Results. All of the experimental groups showed the same levels of incidence and the same patterns of Scoliosis development. Serum melatonin levels were reduced to nearly zero in all the experimental groups for the duration of the experiment. Scoliosis developed in none of the normal chickens. Conclusions. Neither transplantation of the pineal gland into the body wall musculature nor simple cutting of the pineal stalk was able to maintain normal levels of serum melatonin because both procedures reduced levels to nearly zero. The incidence and pattern of Scoliosis development in these groups were the same as those for the pinealectomized group. Reduction of serum melatonin levels remains a prerequisite for Scoliosis development in young chickens.
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the critical stage of pinealectomy surgery after which Scoliosis is produced in young chickens
Spine, 2001Co-Authors: M Beuerlein, Xiaoping Wang, Marc Moreau, V J Raso, J Mahood, J Wilson, B J Greenhill, Keith M BagnallAbstract:Study design Stages of the surgical procedure for pinealectomy in chickens were identified. Groups of chickens were selected for each stage. Scoliosis development was identified from radiographs. Objectives To determine the critical stage of surgery for pinealectomy after which Scoliosis develops in young chickens. Summary of background data Pinealectomy in young chickens consistently produces Scoliosis in young chickens that has many characteristics similar to those seen in patients with adolescent idiopathic Scoliosis. The mechanism behind this phenomenon remains unknown. Methods Five distinct stages in the pinealectomy surgery were identified. Groups of chickens were selected to undergo surgery to represent these five stages. Scoliosis was determined from weekly radiographs. Results Cutting the pineal stalk was identified as the critical stage in the surgery after which Scoliosis developed. The incidence of Scoliosis did not increase after more extensive surgery in which the pineal bulb was removed from the skull. This stage was also correlated with a significant reduction of serum melatonin levels. Conclusions Cutting the pineal stalk was identified as the critical stage of pinealectomy surgery after which Scoliosis may develop. This stage was also correlated with the significant reduction of average serum melatonin levels. These results allow the focus of attention into the mechanism behind this phenomenon to center on the consequences of cutting the pineal stalk rather than total removal of the pineal gland.
-
the effects of melatonin therapy on the development of Scoliosis after pinealectomy in the chicken
Journal of Bone and Joint Surgery American Volume, 1999Co-Authors: Keith M Bagnall, Xiaoping Wang, Marc Moreau, J Mahood, James V Raso, Jie ZhaoAbstract:The mechanism underlying the development of Scoliosis after pinealectomy in young chickens is unknown. However, since the main product of the pineal gland is melatonin, melatonin remains an obvious focus in studies designed to discover this mechanism. One confounding factor is that serum melatonin levels are close to zero after pinealectomy but Scoliosis does not develop in all chickens that have had this procedure. Therefore, the role of melatonin in the development of Scoliosis in chickens after pinealectomy remains controversial. In the current investigation, two pilot studies demonstrated that a physiological therapeutic dose of melatonin (2.5 milligrams per kilogram of body weight) restored the circadian rhythm of melatonin, as measured by serum assay. In the main study, this dose was administered daily starting either immediately after the pinealectomy or two weeks after it, when Scoliosis had developed. Scoliosis was assessed on weekly radiographs, and the Cobb angle was determined for all chickens in which Scoliosis developed. Overall, Scoliosis developed in only 56 percent (fifty) of the eighty-nine chickens that had had a pinealectomy; this rate was consistent throughout all experimental groups. Scoliosis did not develop in any of the control chickens, which did not have a pinealectomy. On the basis of the average Cobb angles in the chickens in which Scoliosis had developed, it was determined that neither the prevalence nor the pattern of the Scoliosis was affected by the therapy in any of the experimental groups. It was thus concluded that melatonin therapy after pinealectomy in young chickens has no effect on the development or progression of Scoliosis. These results raise doubts regarding the role of melatonin in the development of Scoliosis after pinealectomy in the young chicken. CLINICAL RELEVANCE: Although Scoliosis has been produced in some animal studies, none of these models has proved to be entirely satisfactory. Consequently, research regarding adolescent idiopathic Scoliosis has been hampered. Recently, it was shown that Scoliosis with many characteristics similar to those seen in patients who have adolescent idiopathic Scoliosis can be produced consistently in chickens after pinealectomy. This finding encourages the development of this model. An understanding of the mechanism involved in the development of Scoliosis after pinealectomy in chickens might provide new insights into adolescent idiopathic Scoliosis and aid in the development of novel treatment methods.
-
the production of Scoliosis after pinealectomy in young chickens rats and hamsters
Spine, 1999Co-Authors: Cian Okelly, Xiaoping Wang, Marc Moreau, Jie Zhao, J Mahood, James Raso, Keith M BagnallAbstract:Study Design. This study involved weekly radiographic examination of pinealectomized rats, hamsters, and chickens to observe the development of Scoliosis. Objectives. To determine whether pinealectomy produces Scoliosis in animals more closely related phylogenetically to humans than to chickens, namely rats and hamsters, which are representative of mammals. Summary of Background Data. Pinealectomy in 3-day-old chickens has consistently resulted in the development of Scoliosis with many characteristics similar to those seen in patients with adolescent idiopathic Scoliosis. It has not been determined whether this phenomenon is restricted solely to chickens or is applicable to other animals, especially those more closely related to humans. Methods. The pineal gland was removed from young rats, hamsters, and chickens. All animals underwent radiography weekly to detect the development of any Scoliosis. Weight and length measurements were also taken weekly, and serum melatonin levels were determined at the time the animals were killed. Results. Scoliosis was not observed in either the rats or the hamsters. In contrast, Scoliosis developed in 10 of 21 chickens. Serum melatonin levels in all pinealectomized animals were zero. Conclusions. In contrast to the chickens, pinealectomy does not seem to cause Scoliosis in either young rats or hamsters. The reasons for this discrepancy may include differences in the physiology and spinal morphology of the rat and hamster in comparison with the chicken. In the pinealectomized chickens, the results also suggest that future Scoliosis development might be indicated by a significant increase in size when they are compared with pinealectomized chickens that do not develop Scoliosis. Such differences in growth rates also distinguish patients with adolescent idiopathic Scoliosis.
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changes in serum melatonin levels in response to pinealectomy in the chicken and its correlation with development of Scoliosis
Spine, 1998Co-Authors: Xiaoping Wang, Marc Moreau, V J Raso, Jie Zhao, Hongxing Jiang, J Mahood, Keith M BagnallAbstract:Study Design. Normal, sham, and groups of chickens subjected to pinealectomy from which serum melatonin levels were measured and correlated with Scoliosis development in a period of 5 weeks. Objectives. To measure serum melatonin levels in chickens subjected to pinealectomy and control chickens and correlate findings with development of Scoliosis. of Background Data. In a previous study by others, Scoliosis developed in 100% of chickens subjected to pinealectomy, and serum melatonin levels were found to be reduced. Previous results in a study by the authors showed Scoliosis developing in only approximately 55% of chickens that underwent pinealectomy. Methods. Young chickens were subjected to pinealectomy. Control groups consisted of sham operation and normal groups. Radiographs and blood samples were taken at weekly intervals to monitor Scoliosis development and measure serum melatonin levels using radioimmunoassay techniques. Results. Scoliosis developed in only 52% of chickens that underwent pinealectomy, but all had low levels of serum melatonin and no circadian rhythm. The chickens in the two control groups maintained normal serum melatonin levels and rhythms. Conclusions. Pinealectomy in young chickens reduces serum melatonin levels and eliminates the melatonin circadian rhythm. It can also produce Scoliosis, but low levels of serum melatonin are a poor predictor of development of Scoliosis.
John Heydemann - One of the best experts on this subject based on the ideXlab platform.
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increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
Pediatrics, 2020Co-Authors: Lorenzo Deveza, John Heydemann, Frank Gerow, William A Phillips, Darrell Hanson, Benny DahlAbstract:Purpose: Non-idiopathic Scoliosis encompasses a group of diagnoses including neuromuscular, syndromic, and congenital Scoliosis. Neuromuscular Scoliosis includes conditions such as cerebral palsy, muscular dystrophy, and spinal muscular atrophy. Syndromic Scoliosis patients are those with Marfan’s Syndrome, Down Syndrome, and DiGeorge Syndrome. Congenital Scoliosis are patients with a congenitally malformed vertebra. It is known that those with neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic …
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p89 increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
The Spine Journal, 2019Co-Authors: Lorenzo Deveza, John Heydemann, Benny DahlAbstract:BACKGROUND CONTEXT Non-idiopathic Scoliosis encompasses a group of diagnoses including neuromuscular, syndromic and congenital Scoliosis. It is known that those with neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic or congenital Scoliosis do not share the same characteristics and are often treated similarly to those with neuromuscular Scoliosis. The clinical differences between pediatric patients with neuromuscular Scoliosis and syndromic/congenital Scoliosis are not well described. PURPOSE To assess differences in pediatric non-idiopathic Scoliosis patients with neuromuscular Scoliosis (NM) vs syndromic and congenital Scoliosis (SS/CS). STUDY DESIGN/SETTING Retrospective cohort study at a single pediatric institution analyzing all cases involving spinal instrumentation for non-idiopathic Scoliosis comparing NM and SS/CS patients. PATIENT SAMPLE All pediatric patients undergoing spinal instrumentation (n=251) for non-idiopathic Scoliosis at a single institution from 2012-2016. OUTCOME MEASURES Intraoperative estimated blood loss by patient weight (ml/kg); Postoperative blood transfusion (ml); mortality at 30 days and 1 year; surgical site infections (SSI); revision surgery and instrument failure in 1 year; readmission in 30 days; return to OR and emergency room visits in 90 days. METHODS This is a retrospective review of all pediatric patients undergoing spinal instrumentation for non-idiopathic Scoliosis. Neuromuscular Scoliosis (NM) patients (n=112 patients, 128 cases) were compared against syndromic and congenital Scoliosis (SS/CS) patients (n=62 patients, 69 cases). Demographics, patient characteristics and outcomes were compared. Variables were analyzed by students' t-test and Categorical variables were analyzed by Chi-Square Test. RESULTS NM patients were older than those with SS/CS (13.3±3.5 NM vs 11.7±3.5 SS/CS, p=0.002). There were no differences in gender and BMI. In terms of pre-existing conditions, there was a higher percentage of NM patients with pulmonary disease (61.2% NM vs 24.3% SS/CS, p CONCLUSIONS Non-idiopathic patients with NM Scoliosis have different patient characteristics and subsequent postoperative complications than those with SS and CS. NM patients are more likely to have pulmonary disease and seizures. Intra-operatively, NM patients have more blood loss. Postoperatively, NM patients have more complications including SSI, readmission and return to OR at 90 days. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
