Changes in spinal curvature, scoliosis, kyphosis and lordosis are associated with the growth of patients with myelomenmgocele. Previous investigators have stated that progressive developmental scoliosis is related to tethered spinal cord. In order to investigate the relationship of tethered spinal cord release to progression of spinal curvature, we surveyed the medical records of 262 patients with a history of one or more tethered spinal cord release. For 216 of these patients, a total of 2,369 serial spine x-rays, obtained over a 20-year period, were reviewed by the standard Cobb method for progression of scoliosis, thoracic kyphosis and lordosis. In addition, the serial spine x-rays of 74 patients without clinical findings of tethered spinal cord were collected and reviewed for comparison of progressive scoliosis and kyphosis. One hundred and sixty normal lumbar x-rays were evaluated to compare the progression of the lordotic curve in patients with tethered cord release with a normal population. Progression of scoliosis plateaued or declined following release of tethered cord in patients with lumbar and sacral level lesions, however, tether release did not halt the progression of scoliosis in the thoracic level group. Tethered cord release altered the course of lordosis in L1 through L3 level lesions, but had little affect on the normal progression of lordosis in patients with L4, L5 or sacral level lesions. Finally, tethered spinal cord release appears to be associated with a decrease in the incidence and magnitude of kyphosis.
Girls with premature adrenarche (PA) are at risk for multiple problems related to exaggerated androgen synthesis. Whether PA carries a risk of psychopathology remains unknown. This study examined group differences in: (a) anthropometric and endocrine parameters, and (b) mood and behavior problems, in 6-8 year-old girls with PA (n = 40) compared to on-time adrenarche girls (n = 36). PA girls were taller (p ≤0.05) and heavier (p ≤0.01) than the on-time adrenarche girls but body mass index showed no difference. PA girls had significantly (p <0.05) higher adrenal androgen and testosterone concentrations but not cortisol or leptin. PA girls also had significantly more oppositional defiant disorder, and higher symptom counts reflecting anxiety, mood or disruptive behavior disorders. PA girls may be more vulnerable to psychopathology than on-time adrenarche girls. The challenge of future studies is to determine which PA girls are at risk for psychopathology and which are more resilient.
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