The use of a corrective orthopaedic brace is an established form of management for patients with progressive idiopathic scoliosis. Thirteen patients with mild idiopathic scoliosis were studied with and without the corrective brace applied. Lung volumes and the pattern ofchest wall and abdominal movement were measured during quiet breathing. Transdiaphragmatic pressures were measured in six of the patients and upper ribcage movement in seven patients. Application of the brace resulted in a significant reduction in vital capacity (14%), functional residual capacity (22%), and total lung capacity (12%). There was no effect on respiratory rate or minute volume. In the erect position the pattern of chest wall movement was altered with a reduction in lower ribcage movement of 46% and abdominal wall of 39% and an increase in upper ribcage movement of 43%. These changes were greater in the supine position. There was at least a twofold increase in end inspiratory and end expiratory gastric pressures during tidal breathing, but oesophageal pressures were not affected by the brace. Transdiaphragmatic pressures showed a similar twofold increase, which implies a substantial increase in the work of breathing. In view of the doubts concerning the influence of bracing on the natural history of idiopathic scoliosis and the substantial functional effect of bracing on the respiratory system, it is suggested that the current practice ofbracing in this condition needs to be reviewed.
The use ofbracing in the treatment ofmild idiopathic scoliosis is controversial. A study of 33 adolescents showed that bracing significantly decreased lung volumes. Functional residual capacity was reduced by a mean of 26%, 18% of children showing a reduction of greater than 40%. The mean reduction in total lung capacity was 16% and in forced vital capacity 18%. This restriction of lung function by bracing might have a deleterious effect on lung growth or might impose an additional risk factor in the presence ofother disorders, such as asthma and diaphragmatic weakness. The use of bracing in individuals with mild scoliosis should be judiciously reassessed. age was 13-3 years and the mean thoracic Cobb angle 290. In five children the thoracic curve had improved with bracing and at the time of testing was less than 20 degrees. The mean age of onset was 11 7 years (range 6-16 years) and the mean duration ofbracing 1 4 years (range I month-5 years). None of the patients had cardiopulmonary symptoms at the time of testing. Functional residual capacity (FRC) and total lung capacity (TLC) were measured in the sitting position by means of body plethysmography (Jaeger Bodyscreen 2) both with and without the brace. The order of testing-that is, whether the brace was on or offfor the first measurements was randomly selected to allow for a learning effect. All spirometric volumes were corrected to BTPS. The non-deformed height was taken as equal to arm span. In our laboratory the armspan:height ratio estimated from 2368 measurements of 8-18 year old subjects is close to unity (0999 (SD 0 023) for girls and 1 006 (0 022) for boys).The Milwaukee brace reduces lumbar lordosis with a polypropylene pelvic girdle and attempts to correct the thoracic curve with a metal vertical suprastructure on which are mounted pressure pads. The Boston bracing system also uses a polypropylene girdle, which, unlike the former, extends to enclose the lower thorax, again attempting to correct the spinal curve by means of pressure pads mounted on the inner surface, acting on the apices of the curve.Six children with a brace induced reduction in FRC of over 30% were further studied to assess the effect of bracing on oxygen saturation during sleep. Oxygen saturation was monitored overnight with a Nelcor pulse oximeter; studies were performed on two nights, one with and the other without the brace. 959
Little is known about the relative actions of placebo in the acute attack and between attacks. In this study the actions were compared of inhaled salbutamol, inhaled DSCG, and placebo, early and late, in an acute attack of asthma. MethodsThe 35 children studied were admitted with an acute attack of asthma. Fifteen were examined on two occasions late in the attack, and 20 were examined on one occasion early in the attack.Fifteen were examined the following morning, 12-24 hours after admission and again the next day. On the first occasion alternate patients received the drug regimen: placebo (sterile water for injections BP) 2 ml given after measurement of the initial peak expiratory flow rate (PEFR), followed 30 minutes later by salbutamol 5 mg in 2 ml of solution, and 60 minutes later by DSCG 20 mg in 2 ml of solution. Alternate patients received the drugs in the reverse sequence, placebo-DSCG-salbutamol. Preliminary observations had shown that the placebo effect was complete at about 30 minutes, but it is possible that water in the DSCG + salbutamol preparations could have contributed to apparent drug effects, but this does not invalidate the comparison between the drugs. PEFR measurements were repeated at 5-minute intervals throughout the study, and values at 30, 60, and 90 minutes, when maximum effects for each treatment had been reached, were used for statistical analysis. The same children were examined 24 hours later by the alternative drug sequence. A child was eliminated from the study and not given the second sequence if the PEFR failed to be within ± 10O of the value on the first day. In this way the children chosen were ones in whom recovery was prolonged and the clinical state was fairly stable. None of these children was breathless at rest or had tachypnoea, but there was wheeze, and rhonchi were 722 on 11 May 2018 by guest. Protected by copyright.
In 20 male patients suffering from chronic bronchitis and emphysema investigated by pulmonary x-ray densitometry, five different types of densitometer trace pattern were observed during the FEV manoeuvre, which appeared to be related to the degree of zonal airway obstruction and the radiological severity of emphysema. We thought some of the features of the traces were caused by displacement of blood from the area of the lung being examined by trapped alveolar air at a pressure exceeding those in the surrounding blood vessels. A close correlation (P<0001) was found between the conventional FEV1 and the pulmonary densitometer score derived from summated regional observations made during the FEV manoeuvre. A similar high degree of correlation was observed between the FEV1 and a score based on regional radiological appearances. Correlations between Pao2 and Paco2 and the densitometer and x-ray scores were of doubtful significance. The findings indicate that critical evaluation of the radiological features of the pulmonary vessels in patients with emphysema is useful in assessing the overall degree of airway obstruction. Regional densitometer pattern analysis is a valuable contributory method of investigating these patients and -the results of a comparison of these two methods suggest that it may be possible to distinguish between larger and smaller airway obstruction.At the present time, methods of investigating regional ventilation include bronchospirometry, bronchial catheterization with mass spectrometry, and isotope scanning and counting techniques.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.