This study examines the hypothesis of an association between adolescent idiopathic scoliosis (AIS) and eating disorders (EDs). A population of young females affected by AIS has been interviewed for a possible diagnosis of EDs. The proportion of individuals with EDs resulted significantly larger than normative epidemiological data: Prevalences were 9.2% for anorexia nervosa (AN), 7.7% for bulimia nervosa (BN) and 5.3% for eating disorders not otherwise specified (EDNOS). The relationship between EDs and AIS was further tested through a second analysis. Severity of the rachides pathology was correlated with the presence of AN. Our study supports the hypothesis of a comorbidity between AIS and EDs: Some possible clinical explanations for this association are discussed.
[Show abstract][Hide abstract] ABSTRACT: Anthropometric data from three groups of adolescent girls - preoperative adolescent idiopathic scoliosis (AIS), screened for scoliosis and normals were analysed by comparing skeletal data between higher and lower body mass index subsets. Unexpected findings for each of skeletal maturation, asymmetries and overgrowth are not explained by prevailing theories of AIS pathogenesis. A speculative pathogenetic theory for girls is formulated after surveying evidence including: (1) the thoracospinal concept for right thoracic AIS in girls; (2) the new neuroskeletal biology relating the sympathetic nervous system to bone formation/resorption and bone growth; (3) white adipose tissue storing triglycerides and the adiposity hormone leptin which functions as satiety hormone and sentinel of energy balance to the hypothalamus for long-term adiposity; and (4) central leptin resistance in obesity and possibly in healthy females. The new theory states that AIS in girls results from developmental disharmony expressed in spine and trunk between autonomic and somatic nervous systems. The autonomic component of this double neuro-osseous theory for AIS pathogenesis in girls involves selectively increased sensitivity of the hypothalamus to circulating leptin (genetically-determined up-regulation possibly involving inhibitory or sensitizing intracellular molecules, such as SOC3, PTP-1B and SH2B1 respectively), with asymmetry as an adverse response (hormesis); this asymmetry is routed bilaterally via the sympathetic nervous system to the growing axial skeleton where it may initiate the scoliosis deformity (leptin-hypothalamic-sympathetic nervous system concept = LHS concept). In some younger preoperative AIS girls, the hypothalamic up-regulation to circulating leptin also involves the somatotropic (growth hormone/IGF) axis which exaggerates the sympathetically-induced asymmetric skeletal effects and contributes to curve progression, a concept with therapeutic implications. In the somatic nervous system, dysfunction of a postural mechanism involving the CNS body schema fails to control, or may induce, the spinal deformity of AIS in girls (escalator concept). Biomechanical factors affecting ribs and/or vertebrae and spinal cord during growth may localize AIS to the thoracic spine and contribute to sagittal spinal shape alterations. The developmental disharmony in spine and trunk is compounded by any osteopenia, biomechanical spinal growth modulation, disc degeneration and platelet calmodulin dysfunction. Methods for testing the theory are outlined. Implications are discussed for neuroendocrine dysfunctions, osteopontin, sympathoactivation, medical therapy, Rett and Prader-Willi syndromes, infantile idiopathic scoliosis, and human evolution. AIS pathogenesis in girls is predicated on two putative normal mechanisms involved in trunk growth, each acquired in evolution and unique to humans.
[Show abstract][Hide abstract] ABSTRACT: Body deformities in patients with scoliosis significantly affect appearance perception. The majority of studies on this topic have analyzed the relation between radiological and clinical assessment performed by doctors, and patients' perception of deformity. The object of this study was to adapt the Spinal Appearance Questionnaire (SAQ) to Polish conditions and to explore the perception of trunk deformity by female patients with adolescent idiopathic scoliosis.
Forty female patients who underwent surgical treatment for adolescent idiopathic scoliosis using the Cotrel-Dubousset method were asked to complete a Polish version of the Spinal Appearance Questionnaire. The mean preoperative Cobb angle of the thoracic curve in the study group was 55.3 degrees (SD 9.7). In the final postoperative examination the Cobb angle was 29.1 degrees (SD 10.1).
The general results of the SAQ demonstrated that the patients achieved a median of 34.48 points, showing a positive assessment of their appearance. Patients rated themselves most critically in the general, chest, surgical scar, symmetry of shoulders and waist domains. The logistic regression model revealed that only the size of the thoracic apical translation, with a model coefficient of -0.9138 (SE=0.350; p=0.013), has a statistically significant (p=0.002) influence on a good general result in the SAQ.
Patients assessed their appearance positively after surgical treatment. A higher thoracic apical translation value is related to a lower probability of achieving a good general result in the Spinal Appearance Questionnaire.
Medical science monitor: international medical journal of experimental and clinical research 07/2011; 17(7):CR404-10. DOI:10.12659/MSM.881852 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the effect of malnutrition due to anorexia nervosa (AN) on venous blood gases of adolescents with AN hospitalized for medical stabilization.
This retrospective study included 45 adolescents with recent onset (<1 year) AN diagnosed by DSM-IV criteria and excluded subjects with a history of lung disease.
Mean (± SD) age at hospitalization was 15.0 ± 2.0 years; time from onset of symptoms was 6.8 ± 3.0 months; body mass index (BMI) was 15.2 ± 1.5 kg/m(2) ; and minimal nocturnal heart rate (MNHR) was 39.8 ± 7.2 beats/min. On admission, pH was 7.32 ± 0.02, pCO(2) was 53.8 ± 4.6 mm Hg, and HCO(3) was 28.1 ± 2.1 mEq/l. Significant changes (p < .001) occurred during the relatively short hospitalization (9.7 ± 5.1 days): venous pH increased, pCO(2) decreased, HCO(3) decreased, MNHR increased, and heart rate orthostasis decreased. Mild respiratory acidosis (pH < 7.35 and pCO(2) > 45 mm Hg) was observed in 78% of the patients on admission and only in 35% at discharge (p = .0003). Positive correlations were found between % of weight loss and pCO(2) on admission and between BMI on admission and the delta pCO(2) during hospitalization.
Mild respiratory acidosis is common in adolescents with recently diagnosed AN, hospitalized for medical stabilization. Respiratory acidosis improves with bed rest and refeeding. The clinical significance of these findings should be further evaluated.
International Journal of Eating Disorders 01/2012; 45(1):125-30. DOI:10.1002/eat.20911 · 3.13 Impact Factor
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