Study Design. Single-center retrospective cohort analysis. Objective. The aim of this study was to evaluate risk factors associated with the development of proximal junctional kyphosis (PJK) in pediatric neuromuscular scoliosis (NMS). Summary of Background Data. PJK is a common cause of reoperation in adult deformity but has been less well reported in pediatric NMS. Methods. Sixty consecutive pediatric patients underwent spinal fusion for NMS with a minimum 2-year follow-up. PJK was defined as >10° increase between the inferior end plate of the upper instrumented vertebra (UIV) and the superior end plate of the vertebra two segments above. Regression analyses as well as binary correlational models and Student t tests were employed for further statistical analysis assessing variables of primary and compensatory curve magnitudes, thoracic kyphosis, proximal kyphosis, lumbar lordosis, pelvic obliquity, shoulder imbalance, Risser classification, and sagittal profile. Results. The present cohort consisted of 29 boys and 31 girls with a mean age at surgery of 14 ± 2.7 years. The most prevalent diagnoses were spinal cord injury (23%) and cerebral palsy (20%). Analysis reflected an overall radiographic PJK rate of 27% (n = 16) and a proximal junctional failure rate of 7% (n = 4). No significant association was identified with previously suggested risk factors such as extent of rostral fixation (P = 0.750), rod metal type (P = 0.776), laminar hooks (P = 0.654), implant density (P = 0.386), nonambulatory functional status (P = 0.254), or pelvic fixation (P = 0.746). Significant risk factors for development of PJK included perioperative use of halo gravity traction (38%, P = 0.029), greater postoperative C2 sagittal translation (P = 0.030), decreased proximal kyphosis preoperatively (P = 0.002), and loss of correction of primary curve magnitude at follow-up (P = 0.047). Increase in lumbar lordosis from post-op to last follow-up trended toward significance (P = 0.055). Conclusion. Twenty-seven percent of patients with NMS developed PJK, and 7% had revision surgery. Those treated with halo gravity traction or with greater postoperative C2 sagittal translation, loss of primary curve correction, and smaller preoperative proximal kyphosis had the greatest risk of developing PJK. Level of Evidence: 4

Background: Congenital cervical scoliosis is rare, and there is a paucity of literature describing surgical outcomes. We report surgical outcomes in a 17-patient cohort with surgical correction for congenital cervical scoliosis and identify risk factors associated with complications. Methods: Data were retrospectively collected from a single-center cohort of 17 consecutive patients (9 boys, 8 girls) receiving surgical deformity correction for congenital cervical scoliosis. The mean age at surgery was 7.1±3.4 years with an average follow-up of 3.6±1.1 years. Results: There were 24 operations performed on 17 patients, and 4 complications (17%) were reported in the series, including one each of pressure ulcer, asystole, vertebral artery injury, and pseudarthrosis. The mean preoperative major curve angle was 36±20 degrees, which improved to 24±14 degrees (P=0.02). The mean operative time was 8±2 hours with a mean estimated blood loss of 298±690 mL. Halo-gravity traction was used in 5 patients and 6 cases were staged with anterior/posterior procedures. Conclusions: Congenital scoliosis of the cervical spine is a complex process. The spinal deformity of this nature can be managed successfully with carefully planned and executed surgical correction. Level of Evidence: Level IV—retrospective review.

Background: Pregnancy induced hypertension (PIH) adversely affects the development of placenta and growth of fetus. The objectives of this study were to compare the placental diameter, placental thickness and number of cotyledons in mild PIH and severe PIH women versus normotensive women of District D.I.Khan, Pakistan.Material Methods: This comparative cross-sectional study was conducted in Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from January to October 2014. Three samples were selected; each of size 50, group 1 normotensive/ control, group 2 with mild PIH and group 3 with severe PIH. Three research variables; placental diameter (cm), thickness (mm) and number of cotyledons were measured on ratio scale for three groups. Descriptive analysis included mean± SD with 95% confidence intervals for each group separately. With three groups on ratio data, one way-ANOVA test was applied to see significance of difference between three groups. Post hoc Dunnett’s t test was applied at alpha 0.05 to see difference of mild PIH group 2 to normotensive/ control group 1 and of severe PIH group 3 to normotensive/ control group 1separately.Results: Mean placental diameter was 18.28±2.15, 16.57±1.94 and 16.18±1.75 cm and mean placental thickness was 19.33 ±3.70, 19.18±2.78 and 17.60±3.52 mm in group 1, 2 and 3 respectively. Mean number of cotyledons was 14.42±2.25, 14.08±2.30 and 13.16±2.15 in group 1, 2, and 3 respectively. Placental diameter was statistically significantly lower in group 2 (p=.00001) and 3 (p=.00001) than group 1. Placental thickness in group 2 (p=.957) was similar to group 1, while in group 3 (p=.019) it was lower than group 1. Number of cotyledons in group 2 (p=.666) was similar to group 1, while in group 3 (p=.011) it was lower than group 1.Conclusion: In mild pregnancy induced hypertension (PIH), placental diameter was lower than normotensives, while placental thickness and number of cotyledons were similar to normotensives. In severe PIH, placental diameter, placental thickness and number of cotyledons were all lower than normotensives. It is concluded that in mild PIH, the development of placenta is mildly affected, while in severe PIH, the development of placenta is severely affected.

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Purpose In adolescent idiopathic scoliosis (AIS), the rib prominence is a major cosmetic concern which can be improved using thoracoplasties. We sought to determine if the use of deep drains helps minimize the development of pleural effusions after thoracoplasties. Methods Retrospective study of 45 patients with AIS undergoing posterior spinal fusion (PSF) and thoracoplasties. Results Thirty six out of 45 patients (80.0%) required placement of a deep surgical drain, and 16 out of 45 (35.6%) developed pleural effusions after PSF with concomitant thoracoplasty. Of the 16 patients who developed pleural effusion, 12 of 36 (33.3%) required a placement of a deep drain (p > 0.05). Of the total 45 patients in this cohort, 3 patients (6.7%) required chest tubes, and 4 patients (8.9%) developed surgical site infections (SSIs). We found that deep drains were associated with a lower incidence of SSI (2.8% vs 33.3%; p = 0.021). Patients who had a pleural effusion had longer ICU stays (p = 0.037) and longer requirements of nasal oxygen (p = 0.025). Discussion The presence of a pleural effusion in patients with AIS undergoing PSF with thoracoplasty was associated with longer oxygen requirements and length of hospital ICU admission. Thirty six percent of patients with thoracoplasties developed pleural effusions, but deep subfascial drains did not significantly decrease the incidence of pleural effusions.

Introduction Primary cutaneous lymphoma (PCL) is a cutaneous non-Hodgkin’s lymphoma that originates in the skin and lacks extracutaneous spread upon initial diagnosis. The clinical management of secondary cutaneous lymphomas is different from that of PCLs, and earlier detection is associated with better prognosis. Accurate staging is necessary to determine the extent of disease and to choose the appropriate treatment. The aim of this review is to investigate the current and potential roles of 18F- fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET/CT) in the diagnosis, staging, and monitoring of PCLs. Methods A focused review of the scientific literature was performed using inclusion criteria to filter results pertaining to human clinical studies performed between 2015 and 2021 that analyzed cutaneous PCL lesions on 18F PET/CT imaging. Results & Conclusion A review of 9 clinical studies published after 2015 concluded that 18F-FDG PET/CT is highly sensitive and specific for aggressive PCLs and proved valuable for identifying extracutaneous disease. These studies found 18F-FDG PET/CT highly useful for guiding lymph node biopsy and that imaging results influenced therapeutic decision in many cases. These studies also predominantly concluded that 18F-FDG PET/CT is more sensitive than computed tomography (CT) alone for detection of subcutaneous PCL lesions. Routine revision of nonattenuation-corrected (NAC) PET images may improve the sensitivity of 18F-FDG PET/CT for detection of indolent cutaneous lesions and may expand the potential uses of 18F-FDG PET/CT in the clinic. Furthermore, calculating a global disease score from 18F-FDG PET/CT at every follow-up visit may simplify assessment of disease progression in the early clinical stages, as well as predict the prognosis of disease in patients with PCL.

Objectives: To know the causes, magnitude, associated factors & positivecases of polioin village Sumbat, district Swat, a notorious village for polio vaccination refusal.Study Design: This study was conducted in village Sumbat. It was cross-sectional observational study.A cross-sectional survey was conducted utilizing census technique.Methods: 43 families of the area who were refusing to vaccinate their children were visited &interviewed. The data was collected from concerned BHU & district polio eradication centre. The datawas collected by pre-tested structured questionnaire.Results: 5% children were not vaccinated because of refusal. Out of 5% cases 79% refusals were onreligious grounds, 9% were fed up of repetition & rest of 12% were refusing because no positive casesin the area were reported. Refusal was also associated with socioeconomic & educational status of thefamilies. Along with refusal to polio vaccines, considerable cases of refusal to EPI & other vaccinationprograms were also found.Conclusions: We concluded that the refusal cases are increasing gradually & is the major factor in thefailure of eradication of polio. Focusing merely on vaccination is not the only solution to the problem wehave to consider all the factorscontributing to refusal & proper stepsshould be taken in this regard.